Diabetes Res Clin Pract：台北双和医院林俊佃等发现**时相胰岛素分泌是2型糖尿病的触发因素

为了评估在中国人群中，胰岛素敏感性（S1）以及第一（1st ISEC）和第二时相胰岛素分泌（2nd ISEC）在2型糖尿病发展中的相对重要性，来自台湾台北医学大学医学院双和医院的林俊佃教授及其团队进行了一项研究（Beta-cell function and insulin sensitivity at various degrees of glucose tolerance in Chinese subjects），该研究发现1st ISEC是2型糖尿病发展的关键触发因素。该研究结果在线发表在2013年4月15日的《糖尿病研究与临床实践》（Diabetes research and clinical practice）上。
该研究中，共有96例受试者，包括19例正常空腹血糖，21例糖尿病前期和56例2型糖尿病入选。受试者接受改良小剂量分级葡萄糖输注试验（M-LDGGI；Polonsky法的简化版本）和频繁取样静脉葡萄糖耐量试验。结果被解释为对血糖水平，血浆胰岛素变化的斜率。通过观察各自百分比的下降，比较各个参数的变质率。
该研究结果表明，随着空腹血糖（FPG）水平升高，胰岛素敏感性轻度、非显著性降低，而1st ISEC和2nd ISEC大幅度、显著减少。更重要的是，1st ISEC从基线的降幅大于2nd ISEC的降幅。
该研究发现，由于随着FBG的增加，1st ISEC的减少最明显，总结为1st ISEC是2型糖尿病发展的关键触发因素。相反，2nd ISEC在FPG水平增加过程中保持更稳定。后面的发现可以解释胰岛素促泌剂在2型糖尿病早期的有效性。
与糖尿病相关的拓展阅读：

• Diabetes Care：低碳饮食对妊娠期糖尿病无效
• J Med Life：1型糖尿病合并抑郁者转归较差
• Australian Psychologist：精神健康状况可作为糖尿病自我监护指标
• MedPage：加拿大新指南称糖尿病患者40岁时应该使用他汀类药物
• Diabetes Care：维生素D缺乏不能预测糖尿病患者心血管风险 更多信息请点击：有关糖尿病更多资讯

Beta-cell function and insulin sensitivity at various degrees of glucose tolerance in Chinese subjects.
AIMS
The aim of this study was to evaluate the relative importance of insulin sensitivity (SI), and the first (1st ISEC) and second phase insulin secretion (2nd ISEC) in the development of type 2 diabetes (T2D) in Chinese subjects.
METHODS
A total of 96 subjects, including 19 with normal fasting glucose, 21 with pre-diabetes, and 56 with T2D were enrolled. Subjects underwent a modified low dose graded glucose infusion (M-LDGGI; a simplified version of Polonsky's method) and frequently sampled intravenous glucose tolerance test. The results were interpreted as the slope of the changes of plasma insulin against the glucose levels. By observing the respective percentage reduction, the deterioration rate of each parameter was compared.
RESULTS
As fasting plasma glucose (FPG) levels increased, SI decreased mildly and non-significantly, while the 1st and 2nd ISECs decreased more dramatically and significantly. More importantly, the decrease of the 1st ISEC from baseline was greater than that of the 2nd ISEC.
CONCLUSIONS
Since the 1st ISEC decreased the most with increasing FPG levels, it is concluded that the 1st ISEC is the key trigger of T2D development. On the contrary, the 2nd ISEC remained more stable across increasing FPG levels. This latter finding may explain the effectiveness of insulin secretagogues during the early stage of T2D. The results of this study can be helpful in the development of interventions aimed at stopping the progression and/or treating T2D in Chinese populations.