β-cell function, insulin sensitivity, and glucose tolerance in obese diabetic and nondiabetic adolescents and young adults
β-cell function, insulin sensitivity, and glucose tolerance in obese diabetic and nondiabetic adolescents and young adults
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DOI：
10.1210/jc.2005-0853
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发表时间：
2006-01-01
影响因子：
5.8
通讯作者：
D'Alessio, DA
中科院分区：
文献类型：
--
作者：
Elder, DA;Prigeon, RL;D'Alessio, DA
背景：2型糖尿病(T2 DM)估计占儿童糖尿病病例的10%-45%。目的：我们的目标是描述青少年和年轻人T2 DM潜在的代谢缺陷。设计、环境和患者：我们在一个大学医学中心对16名T2 DM青少年和13名肥胖(OB)和13名瘦(LN)年龄匹配的非糖尿病患者进行了胰岛功能和胰岛素敏感性的横断面研究。干预：我们提供口服和静脉葡萄糖耐量试验。主要观察指标：我们测量了胰岛素和胰高血糖素水平，胰岛素敏感性，静脉注射葡萄糖的急性胰岛素反应，结果：糖尿病患者空腹胰岛素水平升高，胰岛素敏感性显著降低(P<；0.05)。T2 DM组和LN组对静脉注射葡萄糖的急性胰岛素反应相似(OB组与LN组和T2 DM组相比P<；0.05)，但经胰岛素抵抗调整的胰岛素分泌(倾向指数)在糖尿病受试者中严重受损(T2 DM组与LN组和OB组比较P<；0.05)。基础状态和刺激状态下三组间胰岛素原与免疫活性胰岛素的比值无差异。结论：糖尿病青少年存在明显的胰岛素抵抗，即使与肥胖和体脂相似的受试者相比也是如此，并且与胰岛素抵抗程度相关的胰岛素分泌受损。然而，青少年糖尿病受试者对葡萄糖的第一时相胰岛素反应与瘦身对照组相当，并且没有高胰岛素原血症或高血糖素血症。
Context: Type 2 diabetes mellitus ( T2DM) is estimated to account for 10 - 45% of incident pediatric diabetes cases.Objective: Our objective was to characterize the metabolic defects underlying T2DM in adolescents and young adults.Design, Setting, and Patients: We conducted a cross-sectional study of islet function and insulin sensitivity in 16 adolescents with T2DM and 13 obese ( OB) and 13 lean (LN) age-matched nondiabetic subjects at a University Medical Center.Intervention: We provided oral and iv glucose tolerance tests.Main Outcome Measures: We measured insulin and glucagon levels, insulin sensitivity, acute insulin responses to iv glucose, and the ratio of proinsulin to immunoreactive insulin.Results: The diabetic subjects had elevated fasting insulin levels and significantly reduced insulin sensitivity ( P < 0.05). The acute insulin response to iv glucose was comparable in the T2DM and LN groups ( P < 0.05 for the OB vs. LN and T2DM), but insulin secretion adjusted for insulin resistance, the disposition index, was severely impaired in the diabetic subjects ( P < 0.05 for the T2DM vs. LN and OB). The ratio of proinsulin to immunoreactive insulin did not differ among the three groups in the basal or stimulated state. Plasma glucagon levels were comparable before and after ingestion of glucose.Conclusions: These findings demonstrate that diabetic adolescents have significant insulin resistance, even compared with subjects of similar obesity and body fatness, and impaired insulin secretion relative to their degree of insulin resistance. However, the adolescent diabetic subjects retained a first-phase insulin response to glucose that was comparable to lean controls and did not have hyperproinsulinemia or hyperglucagonemia.