Insulin clearance as the major player in the hyperinsulinaemia of black African men without diabetes
Insulin clearance as the major player in the hyperinsulinaemia of black African men without diabetes
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DOI：
10.1111/dom.14101
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发表时间：
2020-07-01
影响因子：
5.8
通讯作者：
Goff, Louise M.
中科院分区：
文献类型：
--
作者：
Ladwa, Meera;Bello, Oluwatoyosi;Goff, Louise M.
目的探讨非洲黑人（BA）和欧洲白色人（WE）胰岛素清除率、胰岛素分泌、肝脏脂肪蓄积与胰岛素敏感性的关系。方法23例BA和23例WE男性，糖耐量正常，年龄和体重指数相匹配，采用高胰岛素钳夹技术测定胰岛素分泌和清除，高胰岛素-正常胰岛素钳夹技术结合稳定性葡萄糖同位素灌注测定全身和肝脏特异性胰岛素敏感性，磁共振成像测定肝内脂质（IHL）。结果BA男性具有较高的葡萄糖刺激的外周胰岛素水平（48.1 [35.5，65.2] x 10（3）vs. 29.9 [23.3，38.4] x 10（3）pmol L-1 x min，P= 0.017）和内源性胰岛素清除率较低（771.6 [227.8] vs. 1381 [534.3] mL m（-2）体表面积min（-1），P <0.001）。在β细胞胰岛素分泌或β细胞对葡萄糖的反应性方面没有种族差异，即使在调整了普遍的胰岛素敏感性之后。在WE男性中，内源性胰岛素清除率与全身胰岛素敏感性相关（r = 0.691，P = .001），与IHL呈负相关（r =-0.674，P = .001）。在BA男性中没有发现这些协会。结论虽然正常葡萄糖耐受BA男性有类似的胰岛素分泌反应，他们的WE同行，他们有明显较低的胰岛素清除率，这似乎不能解释胰岛素抵抗或肝脏脂肪堆积。低胰岛素清除率可能是非洲裔人群高胰岛素血症的主要机制。
Aim To investigate relationships between insulin clearance, insulin secretion, hepatic fat accumulation and insulin sensitivity in black African (BA) and white European (WE) men. Methods Twenty-three BA and twenty-three WE men with normal glucose tolerance, matched for age and body mass index, underwent a hyperglycaemic clamp to measure insulin secretion and clearance, hyperinsulinaemic-euglycaemic clamp with stable glucose isotope infusion to measure whole-body and hepatic-specific insulin sensitivity, and magnetic resonance imaging to quantify intrahepatic lipid (IHL). Results BA men had higher glucose-stimulated peripheral insulin levels (48.1 [35.5, 65.2] x 10(3)vs. 29.9 [23.3, 38.4] x 10(3)pmol L-1 x min,P= .017) and lower endogeneous insulin clearance (771.6 [227.8] vs. 1381 [534.3] mL m(-2)body surface area min(-1),P < .001) compared with WE men. There were no ethnic differences in beta-cell insulin secretion or beta-cell responsivity to glucose, even after adjustment for prevailing insulin sensitivity. In WE men, endogenous insulin clearance was correlated with whole-body insulin sensitivity (r = 0.691,P= .001) and inversely correlated with IHL (r = -0.674,P= .001). These associations were not found in BA men. Conclusions While normally glucose-tolerant BA men have similar insulin secretory responses to their WE counterparts, they have markedly lower insulin clearance, which does not appear to be explained by either insulin resistance or hepatic fat accumulation. Low insulin clearance may be the primary mechanism of hyperinsulinaemia in populations of African origin.