Heterogeneity of non-insulin-dependent diabetes expressed as variability in insulin sensitivity, beta-cell function and cardiovascular risk profile
| Autor: | Kristian F. Hanssen, R. Ganss, Bente K. Kilhovd, S. Vaaler, Per Medbøe Thorsby, Kåre I. Birkeland, Peter A. Torjesen |
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| Rok vydání: | 2003 |
| Předmět: |
Adult
Male medicine.medical_specialty Endocrinology Diabetes and Metabolism medicine.medical_treatment Type 2 diabetes chemistry.chemical_compound Endocrinology Risk Factors Diabetes mellitus Internal medicine Internal Medicine medicine Albuminuria Humans Hypoglycemic Agents Insulin Pancreatic hormone C-peptide business.industry Glucose clamp technique Middle Aged medicine.disease chemistry Diabetes Mellitus Type 2 Female Analysis of variance Metabolic syndrome business Diabetic Angiopathies |
| Zdroj: | Diabetic medicine : a journal of the British Diabetic Association. 20(1) |
| ISSN: | 0742-3071 |
| Popis: | Aims The present study investigated the variability in insulin sensitivity and beta-cell function and their relationship to anti-glutamic acid decarboxylase (GAD) positivity and the metabolic syndrome in a group of patients with non-insulin-dependent diabetes mellitus (NIDDM). Methods Fifty-four subjects aged 59.5 +/- 6.1 (mean +/- SD) years with NIDDM for 7.9 +/- 3.9 years referred to hospital due to poor glycaemic control, were investigated. Insulin sensitivity was determined by the euglycaemic hyperinsulinaemic glucose clamp technique as the glucose disposal rate relative to the insulin level obtained (GDRI), and also estimated with the homeostasis model assessment (HOMA-S). beta-cell function was measured by assaying the fasting and glucagon-stimulated C-peptide levels and with the HOMA-B. Results The insulin sensitivity varied 18-fold between subjects when estimated with the clamp and six-fold when estimated with HOMA-S, and was lower the more criteria for the metabolic syndrome present (P = 0.0001 by anova). The beta-cell function varied four-fold when measured as stimulated C-peptide, and eight-fold when estimated with the HOMA-B. The levels of fasting C-peptide and HOMA-B values tended to be lower in anti-GAD+ (n = 11) than in anti-GAD-subjects (P = 0.06 and P = 0.08, respectively). From previously published coronary risk charts, we estimated the 10-year risk of a coronary heart disease (CHD) event to be > 20% in 17 of 39 patients free from cardiovascular disease at the time of study, 16 of whom qualified for a diagnosis of the metabolic syndrome. Conclusions The wide variations in insulin sensitivity and beta-cell function found among subjects with NIDDM support the notion that the disorder is highly heterogeneous. Reduced insulin sensitivity was clearly related to the metabolic syndrome and an increased risk for CHD. |
| Databáze: | OpenAIRE |
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