Improvements in insulin sensitivity and β-cell function (HOMA) with weight loss in the severely obese
Improvements in insulin sensitivity and β-cell function (HOMA) with weight loss in the severely obese
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DOI：
10.1046/j.1464-5491.2003.00889.x
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发表时间：
2003-02-01
影响因子：
3.5
通讯作者：
O'Brien, PE
中科院分区：
文献类型：
--
作者：
Dixon, JB;Dixon, AF;O'Brien, PE
目的探讨减肥对不同血糖控制的重度肥胖患者胰岛素敏感性和β细胞功能的影响。患者与方法选取254例（F:M 209:45）重度肥胖可调节胃束带患者，对照术前和随访1年的生化数据。采用稳态模型评估法计算胰岛素敏感性（HOMA%S）和β细胞功能（HOMA%B）。受试者按糖尿病状态和减重前HbA（1c）分组。结果初始平均（sd）体重和身体质量指数分别为128 (26)kg和46.2 (7.7)kg/m(2)， 1年后分别为101 (22)kg和36.4 (6.7)kg/m(2)。超重减重率（%EWL）为44.3%(14)%。HOMA%S从手术前的37.5%(16)%提高到62 (25)% （P < 0.001）。%EWL是HOMA%S改善的唯一预测因子（r = 0.28, P < 0.001）。空腹血糖正常、空腹血糖受损和2型糖尿病患者的HOMA%B分别下降、无变化和增加。糖尿病患者（n = 39） HOMA%B的改善程度与糖尿病患者患病时间呈负相关（r = -0.36, P = 0.02）。在非糖尿病受试者中，HOMA%S-HOMA%B的关系随着体重减轻而改变，因此对于任何给定的HOMA%S， HOMA%B都会增加（f = 11.8, P = 0.001）。HOMA%B的改善与%EWL呈正相关（r = 0.25, P = 0.019）。随着体重减轻，胰岛素敏感性和β细胞功能都有有益的变化。现代腹腔镜肥胖手术可能在肥胖患者2型糖尿病的早期治疗中发挥重要作用。
Aims To examine the effect of weight loss on insulin sensitivity and beta-cell function in severely obese subjects of varying glycaemic control.Patients and methods Subjects were 254 (F:M 209:45) patients having adjustable gastric banding for severe obesity, with paired biochemical data from before operation and at 1-year follow up. The homeostatic model assessment method was used to calculate insulin sensitivity (HOMA%S) and beta-cell function (HOMA%B). Subjects were grouped by diabetic status and by pre-weight loss HbA(1c) .Results Initial mean (sd) weight and body mass index were 128 (26) kg and 46.2 (7.7) kg/m(2) , respectively, and at 1-year were 101 (22) kg and 36.4 (6.7) kg/m(2) . The percentage of excess weight lost (%EWL) was 44.3 (14)%. HOMA%S improved from 37.5 (16)% presurgery to 62 (25)% (P < 0.001). %EWL was the only predictor of HOMA%S improvement (r = 0.28, P < 0.001). Subjects with normal fasting glucose, impaired fasting glucose and Type 2 diabetes had a fall, no change and increase in HOMA%B, respectively. The improvement in HOMA%B in subjects with diabetes (n = 39) was inversely related to the time with diabetes (r = -0.36, P = 0.02). In non-diabetic subjects the HOMA%S-HOMA%B relationship was favourably altered with weight loss, so that for any given HOMA%S there was an increase in HOMA%B (f = 11.8, P = 0.001). This improvement in HOMA%B was positively related to %EWL (r = 0.25, P = 0.019).Discussion There are beneficial changes in both insulin sensitivity and beta-cell function with weight loss. Modern laparoscopic obesity surgery may have an important early role in the management of Type 2 diabetes in obese subjects.