中国糖尿病流行现状.pptVIP

* 虽然代谢综合症各组分在中国人群中的患病率均较高，但是研究发现对于中国的2型糖尿病患者而言，推动病情进展的是胰岛BETA细胞功能的降低，而并非胰岛素敏感性的改变。 随着糖代谢异常程度的增加，胰岛素敏感性降低不明显，而是胰岛素分泌量的减少推动了病情的进展。 目的 明确中国2型糖尿病早期的发病机制 方法 N=2975，以OGTT分为NGT、IGR、DM 胰岛素敏感性指标: OGIS 、HOMA-S% 胰岛素分泌量指标: IGI (Ins30-Ins 0)/(Glu30-Glu0) HOMA-B% 结果显示： IGT、IFG及CGI患者的胰岛素分泌量显著低于正常患者，而且IFG患者的胰岛素分泌量较IGT患者明显减少；同样CGI患者的胰岛素分泌量较IFG患者的亦明显减少。 结果提示随着患者血糖调节功能异常的加剧，胰岛素的分泌量呈进行性降低。即糖尿病早期发生糖调节受损及主要机制为胰岛素分泌减少。 * 早相胰岛素分泌缺陷在IGT向T2DM进展中发挥重要作用 * 188新诊断的T2DM与38正常人 * This graph is often used to understand the difference between Japanese and Caucasian diabetes. and you can see Caucasians insulin profile on OGTT in orange lines, Normal and IGT While Japanese one in blue lines clearly smaller amount of insulin secretion both in Normal and IGT. Therefore, typical Japanese diabetic patients have lower and more flat pattern than IGT. It is said that only half amount of insulin is secreted in Japanese compared to Caucasians. Although developing type 2 diabetes needs two major factors, insulin deficiency and insulin resistance, for Japanese insulin deficiency is the primary cause of type 2 DM rather than insulin resistance as seen in most Caucasian type 2 DM. * 该研究对873例怀疑有糖代谢异常但是未经过任何降糖药治疗的患者进行75g口服糖耐量及胰岛素、C-P释放试验，根据结果分为NGT, PreDM, DM， 纳入该研究的时间点定义为诊断为糖代谢异常并且给与干预治疗之时。 Early phase insulin secretion decreased rapidly according to the increments of Glc0, Glc120 and A1c, and these changes were most prominent in the NGT stage. Compared to the control group, the early phase insulin secretion levels of the preDM or T2DM subjects were less than 50% when Glc0 was over 100 mg/dL, Glc120 was over 145 mg/dL, and A1c was over 5.8%. Conclusion: This study suggests that progressive beta cell dysfunction in Koreans may be initiated and rapidly aggravated during the period generally designated as ‘normal.’ IGI = (Ins30 – Ins0) / (Glc30 – Glc0) ACR = (Cpep30 – Cpep0) / (Glc30 – Glc0) HOMAβ = (20 × Ins0) / [(Glc0 / 18) – 3.5] HOMA-IR = (Ins0 × Glc0) / 405 QUICKI