| OBJECTIVE:To understand the situation of the patients who were suffering steroid diabetes mellitus (SDM), especially the change in the first-phase insulin secretion, explored the differential diagnosis value of the first-phase insulin secretion in clinical diagnosis and treatment between SDM and type 2 diabetes (T2DM).METHODS:A total of 60 patients were selected, who was Cushing’s syndrome (CS) or iatrogenic CS from the First Affiliated Hospital of Guangxi Medical University, from January,2011 to March,2016, including 34 males,26 females, where in the CS 25 patients (3 males,22 females), iatrogenic CS 35 patients (31 males,4 females), meanwhile collecting 69 people as control (48 males,21 females).According to the OGTT test, hypercortisolism group is divided into steroid diabetes group, hypercortisolism impaired glucose regulation group and hypercortisolism normal glucose tolerance group; the control group is divided into T2DM group, IGR group, NGT group.The patients’ clinical datas were collected, including their gender, age, height, weight, course of the disease, systolic blood pressure (SBP), diastolic blood pressure (DBP), blood lipids, liver function and glycated hemoglobin (HbAlc), OGTT and IVGTT were tested simultaneously. The acute phase insulin secretion (AIR0-10min), area under the curve of insulin (AUCins0-10min) in IVGTT were used to assessing the function of the first-phase insulin secretion. Homeostasis model assessment of insulin resistance (HOMA-IR) in OGTT was evaluated the state of insulin resistance. AUCins0-3h and area under the curve of insulin/area under the curve of glucose (AUCins/AUCglu0-3h) in OGTT were used to assessing the function of the second-phase insulin secretion. While modified beta cell function index (MBCI), homeostasis model assessment of insulin secretion (HOMA-P) and peak insulin/fasting insulin (Ip/I0) were used to evaluating the function of islet beta cells secretion. Collectively discussing whether there was a difference between SDM and T2DM about the islet function, especially the funtion of the first-phase insulin secretion.RESULTS:1.The proportion of DM,IGR,NGT in patients with hyperctisol-ism were respectively 43.3%,33.3%,23.3%, and the proportion of rise in simple fasting blood glucose, simple postprandial blood glucose, both fasting and postprandial blood glucose in SDM patients were respectively 3.8%,73.1%, 23.1%,65.0% of patients with hypertension at the same time, and SDM patients had earlier age of onset than T2DM patients, with higher TC, HDL and blood pressure.2.In OGTT test,HOMA-IR and HOMA-P in hypercortisolism group were higher than the control group, but there was no significant difference between them (P>0.05); in hypercortisolism group, AUCinso-3h, AUCins/AUCglu0-3h in IGR、DM group were higher than the corresponding control, the difference was statistically significant (P<0.05); In the control group,MBCI of NGT group is higher than IGR、DM group (P<0.05).3.In IVGTT test, in addition to insulin secretion curve in the T2DM was low and flat, no significant secretion peak, insulin secretion peak in the remaining groups was mostly between 2 and 4 min; Ip, Ip/I0,AIR0-10min,AUCins0-10min in SDM group were higher than the T2DM, the difference was statistically significant (P<0.05).CONCLUSIONS:1.SDM incidence was higher in patients with hypercotisolism,and early onset age compared with type 2 diabetes, postprandial hyperglycemia in main, mostly associated with high blood pressure.2.The function of insulin secretion in SDM was better than T2DM patients, existence of the first-phase secretion, especially in detecting IVGTT Ip/I0 can be used as a SDM and T2DM index of differential diagnosis. |
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