The associations of body mass index, C-peptide and metabolic status in Chinese Type 2 diabetic patients
The associations of body mass index, C-peptide and metabolic status in Chinese Type 2 diabetic patients
复制标题
DOI：
10.1111/j.1464-5491.2004.01158.x
复制
发表时间：
2004-04-01
影响因子：
3.5
通讯作者：
Chan, JCN
中科院分区：
文献类型：
--
作者：
Chan, WB;Tong, PCY;Chan, JCN
背景中国2型糖尿病受试者通常比白人受试者更不肥胖。我们假设瘦型和肥胖型中国2型糖尿病患者具有不同的代谢和胰岛素分泌特征。我们比较了瘦/正常体重和肥胖的糖尿病subjects.Study设计之间的临床特征，C肽和代谢状态，我们进行了一项横断面研究，对521连续糖尿病患者新提到的糖尿病诊所在1996年。根据WHO重新定义的亚太地区肥胖标准，将受试者分为体重不足（< 18.5 kg/m2）、正常体重（18.5-23 kg/m2）和超重（大于或等于23 kg/m2）。代谢和人体测量参数进行了比较组之间的不同程度的obesity.Results，在这个队列中，5.8%，30.6%和63.7%的受试者体重不足，正常体重和超重，分别使用“亚洲”标准。在这521例受试者中，20%的受试者空腹C肽低于0.2 nmol/l，提示胰岛素缺乏。调整病程后，空腹C肽随BMI呈线性上升趋势（P < 0.001），HbA 1c随BMI呈下降趋势（P = 0.001）。低体重组接受胰岛素治疗的受试者较多（41.3% vs. 13.9%和8.2%，P < 0.001）。虽然三组间的稳态模型评估相似，但收缩压（P = 0.006）和舒张压（P < 0.001）和甘油三酯（P < 0.001）显示升高，而HDL-C（P <0.001）显示降低，这是不同BMI组的趋势。低体重组C肽水平最低，HbA（1c）水平最高，超重组C肽、血压、甘油三酯水平最高，HbA（1c）水平最低。临床医生应该有较低的阈值，开始胰岛素治疗的瘦型2型糖尿病患者与次优的血糖控制。在肥胖糖尿病患者中，积极控制多种心血管风险尤为重要。
Background Chinese Type 2 diabetic subjects are generally less obese than their Caucasian counterparts. We hypothesized that lean and obese Chinese Type 2 diabetic subjects have different metabolic and insulin secretory profiles. We compared the clinical features, C peptide and metabolic status between lean/normal weight and obese diabetic subjects.Study design We conducted a cross-sectional study on 521 consecutive diabetic subjects newly referred to a Diabetes Clinic in 1996. The subjects were categorized into underweight (< 18.5 kg/m(2)), normal weight (18.5-23 kg/m(2)) and overweight (greater than or equal to 23 kg/m(2)) according to the re-defined WHO criterion for obesity in Asia Pacific Region. Metabolic and anthropometric parameters were compared between groups with different levels of obesity.Results In this cohort, 5.8, 30.6 and 63.7% of subjects were underweight, normal weight and overweight, respectively, using the 'Asian' criteria. Of these 521 subjects, 20% had fasting C-peptide less than 0.2 nmol/l, suggesting insulin deficiency. Fasting C-peptide showed linear increasing trend (P < 0.001) while HbA(1c) showed decreasing trend (P = 0.001) with BMI after adjustment for duration of disease. There were more subjects in the underweight group who were treated with insulin (41.3% vs. 13.9 and 8.2%, P < 0.001). Although homeostasis model assessment was similar amongst the three groups, systolic (P = 0.006) and diastolic blood pressure (P < 0.001) and triglyceride (P < 0.001) showed increasing, while HDL-C (P < 0.001) showed decreasing, trends across different BMI groups. The underweight patients had the lowest C-peptide and highest HbA(1c) while overweight patients had the highest C-peptide, blood pressure, triglyceride but lowest HbA(1c) levels.Conclusion In Chinese Type 2 diabetic patients, lean subjects had predominant insulin deficiency and obese subjects had features of metabolic syndrome. Clinicians should have low threshold to initiate insulin therapy in lean Type 2 diabetic patients with suboptimal glycaemic control. In obese diabetic patients, aggressive control of multiple cardiovascular risks is of particular importance.