ARE SPECIFIC SERUM-INSULIN LEVELS LOW IN IMPAIRED GLUCOSE-TOLERANCE AND TYPE-II DIABETES - MEASUREMENT WITH A RADIOIMMUNOASSAY BLIND TO PROINSULIN, IN THE POPULATION OF WADENA, MINNESOTA
ARE SPECIFIC SERUM-INSULIN LEVELS LOW IN IMPAIRED GLUCOSE-TOLERANCE AND TYPE-II DIABETES - MEASUREMENT WITH A RADIOIMMUNOASSAY BLIND TO PROINSULIN, IN THE POPULATION OF WADENA, MINNESOTA
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DOI：
10.1016/0026-0495(95)90045-4
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发表时间：
1995-10-01
影响因子：
9.8
通讯作者：
CLEMENTS, JP
中科院分区：
文献类型：
--
作者：
GOETZ, FC;FRENCH, LR;CLEMENTS, JP
有人认为，新近确诊的II型糖尿病患者的血清胰岛素水平被高估了，校正胰岛素原后，真正的胰岛素水平降低而不是升高。我们对居住在瓦迪纳的328名成年人进行了一项基于人口的横断面研究，测试了这种可能性。瓦迪纳是明尼苏达州的一个社区，居民有北欧背景。胰岛素测定的特异性是由对胰岛素原及其主要代谢物盲目的抗体提供的。分别在不同的日子进行口服葡萄糖耐量和液体混合餐(Enure-Plus)试验。混合餐前和餐后90分钟的平均胰岛素水平如下。在随机确定的302名先前未知患有糖尿病的成年人中，糖耐量受损(IGT)患者和新发现的II型糖尿病患者的空腹和餐后水平都等于或高于糖耐量正常者的水平(空腹：正常52pmol/L，IGT 78，新的II87：餐后：317,565和406)。IGT和新的II型糖尿病患者的空腹胰岛素/血糖比值显著升高。在26名确诊的(以前已知的)未服用胰岛素的II型糖尿病患者中，空腹水平升高，餐后狂欢绝对值正常(75和328)，但血糖正常或低。对体重指数(BMI)、性别、年龄或血压进行调整后，这些组之间的关系没有发生实质性变化。个体胰岛素水平在组与组之间有明显的重叠。总而言之，在瓦迪纳随机选择的患有IGT或无症状糖尿病的成年人平均显示胰岛素水平升高，但医生诊断的糖尿病与血清胰岛素的相对下降有关。在这一人群中，目前关于“早期”糖尿病胰岛素抵抗的观点得到了胰岛素特异性测量的支持。版权所有(C)1995，由W.B.Saunders公司
It has been suggested that serum insulin levels in subjects with recently diagnosed type II diabetes have been overestimated, and that after correction for proinsulin, true insulin levels are depressed rather than elevated. We tested this possibility in a cross-sectional study of a population-based sample of 328 adults living in Wadena, a Minnesota community in which residents are of northern European background. Specificity of insulin measurements was provided by an antibody blind to proinsulin and its major metabolite. Oral glucose tolerance and liquid mixed-meal (Ensure-Plus) tests were performed on separate days. Mean insulin levels before and 90 minutes after the mixed meal were as follows. Among 302 randomly ascertained adults not previously known to have diabetes, both fasting and postmeal levels in subjects with impaired glucose tolerance (IGT) and newly identified type II diabetes were equal to or greater than levels in subjects with normal glucose tolerance (fasting: normal 52 pmol/L, IGT 78, new type II 87: postmeal: 317, 565, and 406, respectively). The fasting insulin to glucose ratio was significantly increased in IGT and new type II diabetes subjects. Among 26 established (previously known) type II diabetic subjects not taking insulin, fasting levels were elevated and postmeal revels were normal in absolute terms (75 and 328), but were normal or low with respect to plasma glucose. Relationships among the groups were not materially changed by adjustment for body mass index (BMI), sex, age, or blood pressure. There was marked overlap of individual insulin levels from group to group. In summary, randomly selected adults in Wadena with IGT or asymptomatic diabetes showed, on average, elevated insulin levels, but physician-diagnosed diabetes was associated with relative diminution of serum insulin. In this population, the current view of insulin resistance in ''early'' diabetes was supported by insulin-specific measurements. Copyright (C) 1995 by W.B. Saunders Company