The Assesment Of Insulin Resistance In The Normal Glucose Tolerance,Hyperinsulinemia With Normal Blood Glucose And Impaired Glucose Tolerance Crowds

Insulin resistance(IR)andβcell function decrease are the major pathogenesy of type 2 diabetes mellitus.IR wildly existed in many pathological and physiological statements,some scholar suggested that T2DM should be devided into 3 phases:hyperinsulinemia stage,pre-diabetes(IGT,IFG)and diabetes.That is to say HINS and IGT are the "reserves" for T2DM.In this research,we will assess the IR level of NGT,HINS and IGT groups with the "gold stander" hyperinsulinemic-euglycemicclamp technique,it can be devided into 2 parts:1.Establishment of hyperinsulinemic-euglycemic clamp techniqueObjective:To establish a hyperinsulinemic-euglycemic clamp technique,a method for the precise measurement of insulin sensitivity.And compare the differences of the establishmental condition among the NGT,HINS and IGT groups.Methods:A hyperinsulinemic-euglycemic clamp technique was applied to the study of methodology in 10 NGT,11 HINS,10 IGT subjects,compare the differences of the establishmental condition among the three groups through variance analysis(ANOVA),and investigated the influencing factors result in these differences through stepwise regression analysis.Result:The serum insulin concentration of the three groups were acutely raised and maintained at above 100 mU/L.During the steady stage,the blood glucose level were kept stable,CV were all with in 5%.The secretion of endogenous insulin and hepatic glucose production were completely inhibited during the test.During the clamp, the peak and steady-state serum insulin concentration of IGT group and HINS group were significantly higher than NGT group,but had no statistical significance differences between IGT group and HINS group(p=0.34 and 0.11). The independence influencing factors of the peak serum insulin concentration were waist-to-hip ratio(WHR),and of the steady-state serum insulin concentration were insulin metabolic clearance rate(MCR)and body mass index (BMI).The peak and steady-state serum insulin concentration were not the independent influencing factors of M value,but they were the independent influencing factors of(M/I)~*100.Conclution:①The hyperinsulinemic -euglycemic clamp technique is successfully established on NGT group,HINS group and IGT group;②Although there were differences among the three groups on peak and steady-state serum insulin concentration,the differences did not influence the using of M value to evaluat insulin resistance.2.The Assesment Of IR In The NGT,HINS And IGT CrowdsObjective:To evaluate the differences on IR level among the NGT,HINS And IGT groups,analyse the relative dangerance factors of insulin sensitivity. Methods:10 NGT,12 HINS and 17 IGT subjects take part in this research, hyperinsulinemic-euglycemic clamp technique was performed in all of them,in order to evaluate the differences on IR level among the three groups,analyse the relative influencing factors of insulin sensitivity index-M through linear correlation and stepwise regression method.Caculate the simple insulin sensitivity indexes,analyse the associativity of the simple indexes and the gold standard of IR-M value.Result:The M values of NGT,HINS and IGT are as followed:(11.56±1.74)mg/kg/min,(6.20±1.81)mg/kg/min and(6.58±1.68) mg/kg/min,M values of HINS and IGT groups were statistical significance lower than the NGT group(p＜0.01),but the differences between HINS and IGT group had no statistical significance(P=0.57).Analyse the relative influencing factors of M value through the the stepwise regression equation,the values which finally entered the equation were as followed:waist-to-hip ratio,fasting insulin level,LDL-C,the correlation coefficient of the model was 0.87. Sub-group analysis:①sub-group analyse according to BMI,both in HINS group and IGT group,followed the increase of BMI,the M values had a tendency of decline.②In HINS group,the M value of the fasting hyperinsulinemia sub-group(fasting insulin level＞15uIU/ml)was 6.09±2.23 mg/kg/min,and of the none fasting hyperinsulinemia sub-group(fasting insulin level<15uIU/ml)was 6.43±0.63 mg/kg/min,the differences between them had no statistical significance(p=0.69);In IGT group,the M value in the fasting hyperinsulinemia sub-group was 5.16±1.26 mg/kg/min,in the none fasting hyperinsulinemia sub-group was 7.61±1.03mg/kg/min,fasting hyperinsulinemia sub-group was significantly lower than the none fasting hyperinsulinemia sub-group(P=0.0011);③The compairasion between the fasting hyperinsulinemia subjects in HINS group and IGT group,the differences between them had no statistical significance(p=0.30).The simple insulin sensitivity indexes Ln[1/(FBG~*FINS)],HOMA-IR,FINS,QUICKI,1/(FPG~*FINS),FINS/FBG, Ln(HOMA-IR)were all significantly associativity with M value,the correlation coefficients(r)were as followed:0.74,0.71,0.70,0.69,0.64,0.60(p＜0.01)and 0.48(p=0.0017).Conclusion:IR existed in both HINS group and IGT group, and they have the same IR level.The influencing factors of IR were as followed: WHR,fasting insulin level,LDL-C,BMI,et al.Some simple insulin sensitivity indexes especially Ln[1/(FBG~*FINS)],HOMA-IR and FINS have significantly associativity with M value in the NGT,HINS and IGT groups,these indexes were applicable to evaluate IR in these groups.