Study On Compensatory Hypersecretion Of Insulin In Obese Patients

Objective:To study the characteristics and mechanism of compensatory hypersecretion of insulin in obese peopleMethods:Since December 2019 to December 2021,the project group recruited subjects without history of diabetes and with different obesity from the society,Outpatient department,ward and physical examination center of geriatrics department and general medicine department of the First Affiliated Hospital of Hainan Medical University.After conditional screening,a total of 92subjects were selected as subjects.According to body mass index（BMI）,they were divided into high body mass index group（HBMI group,BMI≥27kg/m²,33）,mild body mass index group（MBMI group,24kg/m²≤BMI<27kg/m²）and normal body mass index group（NBMI group,18.5kg/m²≤BMI<24 kg/m²）.In different weight groups,insulin at each time point of OGTT,insulin production index（△I30/△G30、△I120/△G120）and the ratio of area under insulin curve to area under glucose curve（AUCI/AUCG）were used to study the changes of insulin secretion,HOMA-IR and Matsuda were used to study the changes of insulin sensitivity,and it is to study biochemical function changes.Results:（1）There was no difference in age and gender among the three groups（P>0.05）.（2）There were significant differences in fasting,30,60,120and 180min insulin secretion among the three groups（P<0.01 or P<0.05）,among which the insulin secretion increased continuously to 120 points in HBMI group,and 60 points in MBMI group,after glucose load.Fasting,30,60 and 120 min insulin secretion in HBMI group and MBMI group were higher than those in NBMI group,and 180 min insulin secretion in HBMI group was also higher than that in NBMI group（P<0.01or P<0.05）.The insulin production ability of△I30/△G30,△I120/△G120 and AUCI/AUCG under glucose stimulation was significantly different among the three groups（P<0.01 or P<0.05）.Among them,the insulin value increased significantly at120 min in the late phase in the HBMI group,and△I30/△G30,AUCI/AUCG and HOMA-βincreased,and theβcell secretion function was enhanced in the HBMI group.（3）There were differences in HOMA-IR and Matsuda among the three groups（P<0.01）,in which HOMA-IR was higher and Matsuda was lower in the HBMI group（P<0.01 or P<0.05）.In HBMI group and MBMI group TG was higher than that in NBMI group,and FPG in MBMI group was lower than that in NBMI group（P<0.01 or P<0.05）.TG was the highest in HBMI group.FPG and 2h PG were the highest in the NBMI group.（4）According to the peak value of insulin(INS_max),the patients were divided into high insulin secretion group（HINS）and low insulin secretion group（LINS）,those are all 46 case.The levels of BMI,30 min and 120 min insulin(INS₃₀and INS₁₂₀)in HINS group were higher than those in LINS group（P<0.01）.（5）The regression analysis showed that BMI have a positive correlation and effect on HOMA-β,INS₃₀,INS₁₂₀,AUCI/AUCG and HOMA-IR,and a negative impact on Matsuda（P<0.05）.BMI increased insulin secretion and insulin resistance.INS_maxhas a positive impact on BMI、TG and HOMA-IR resistance,（P<0.05）.Conclusion:In obese individuals,insulin hypersecretion is characterized by increased insulin in the late phase.It is a compensatory hypersecretory response to maintain blood glucose homeostasis.It is the internal pathophysiological changes of obese people and the beginning of abnormal glucose metabolism.It is interdependent with insulin resistance,accompanied by increased fat synthesis,but has nothing to do with metabolism such as cholesterol.When insulin compensation is insufficient,it can not maintain blood glucose homeostasis and increase blood glucose.