Insulin sensitivity of blood glucose versus insulin sensitivity of blood free fatty acids in normal, obese, and obese-diabetic subjects
Insulin sensitivity of blood glucose versus insulin sensitivity of blood free fatty acids in normal, obese, and obese-diabetic subjects
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DOI：
10.1053/meta.2001.22518
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发表时间：
2001-05-01
影响因子：
9.8
通讯作者：
Cavaleri, A
中科院分区：
文献类型：
--
作者：
Belfiore, F;Iannello, S;Cavaleri, A
我们计算了34名正常人、27名肥胖者和11名肥胖糖尿病受试者的胰岛素敏感性指数（ISI），分别称为ISI（gly）和ISI（ffa），其中ISI涉及胰岛素对空腹和血液游离脂肪酸（FFA）的影响，计算公式如下：ISI（gly）= 2/[（INSp x GLYp）+1]，ISI（ffa）= 2/[（INSp x FFAP）+1]，其中INSp、GLYp和FFAP =口服葡萄糖耐量试验（OGTT）期间的胰岛素血、血糖和FFA面积（75 g葡萄糖，建议采样时间：0、1和2小时）。对这些公式稍作修改，即可计算胰岛素抵抗指数（IRI），即IRI（gly）和IRI（ffa）。ISI和IRI是互补的，因为它们的和总是等于2，所以IRI可以从ISI推导出来，反之亦然。通过使用基础水平而不是面积，也可以测量基础状态下的胰岛素敏感性（或抵抗）。基础水平和面积通过将平均正常值取为1来表示，使得在正常受试者中，ISI（gly）和ISI（ffa）以及IRI（gly）和IRI（ffa）总是在1左右，最大变化包括在0和2之间。肥胖者（平均值0.47 ± 0.04）和肥胖糖尿病患者（平均值0.41 ± 0.06）的ISI（ffa）均显著降低，而肥胖者（平均值0.57 ± 0.04）的ISI（gly）降低程度低于肥胖糖尿病患者（平均值0.40 ± 0.03）。在两组中，ISI（gly）-basal比ISI（ffa）-basal受影响更小。多元回归分析显示，ISI（gly）和ISI（ffa）与年龄、体重指数（BMI）和舒张压（而非收缩压）呈显著负相关。对文献数据的荟萃分析表明，ISI（gly）与高胰岛素-正葡萄糖钳夹数据显着相关。然而，"钳夹"是在人工持续性高胰岛素血症（需要FFA抑制）下进行的，这在患者的生活中从未发生过，而我们的指数是在生理条件下进行的，代表了适用于临床或流行病学研究的简单工具，允许评估全身胰岛素敏感性与胰岛素和血液FFA。版权所有（C）2001 W.S.桑德斯公司
We calculated insulin sensitivity indices (ISI) concerning the insulin effect on both glycemia and blood free fatty acids (FFA), named ISI(gly) and ISI(ffa), respectively, in 34 normal, 27 obese, and 11 obese-diabetic subjects by using the following formulas: ISI(gly) = 2/[(INSp x GLYp) +1], and ISI(ffa)= 2/[(INSp x FFAp)+1], in which INSp, GLYp, and FFAp = insulinemic, glycemic, and FFA areas during oral glucose tolerance test (OGTT) (75 g glucose, suggested sampling time: 0, 1, and 2 hours) of the person studied. A slight modification of these formulas allows the calculation of insulin resistance indices (IRI), ie, IRI(gly) and IRI(ffa). ISI and IRI are complementary, as their sum is always equal to 2, so that IRI can be deduced from ISI and vice verse. By using basal levels instead of areas, insulin sensitivity (or resistance) in the basal state can also be measured. Basal levels and areas are expressed by taking the mean normal value as 1, so that in normal subjects ISI(gly) and ISI(ffa), as well as IRI(gly) and IRI(ffa), are always around 1, with maximal variations comprised between 0 and 2. ISI(ffa) was markedly reduced in both the obese (mean, 0.47 +/- 0.04) and the obese-diabetic (mean, 0.41 +/- 0.06) subjects, whereas ISI(gly) was less reduced in the obese (mean, 0.57 +/- 0.04) than in the obese-diabetic (mean, 0.40 +/- 0.03) subjects. ISI(gly)-basal was less affected than ISI(ffa)-basal in both groups. Multiple regression showed that ISI(gly) and ISI(ffa) were significantly inversely correlated with age, body mass index (BMI), and diastolic (but not systolic) blood pressure. Meta-analysis of data from the literature showed that ISI(gly) was significantly correlated with the hyperinsulinemic-euglycemic clamp data. However, the "clamp" is performed under artificial, persistent hyperinsulinemia (which entails FFA suppression) as never occurs in the life of patients, whereas our indices are performed under physiologic conditions, and represent simple tools suitable for clinical or epidemiologic studies, allowing assessment of whole-body insulin sensitivity with regard to both glycemia and blood FFA. Copyright (C) 2001 by W.S. Saunders Company.