胰島素阻抗、葡萄糖有效度、第一及第二期胰島素分泌在決定高齡華人婦女的葡萄糖代謝異常之角色

The importance of insulin resistance, glucose effectiveness, first and second phase insulin secretion in determining having glucose dysregulation in obese old Chinese women

背景：老年肥胖受試者特別容易罹患2型糖尿病的併發症。胰島素抵抗（IR），葡萄糖有效度（GE），第一和第二階段胰島素分泌（FPIS，SPIS）被認為是誘導糖尿病的病理生理因素。在這項研究中，我們測量了IR，FPIS，SPIS和GE，以確定哪一種對葡萄糖失調（糖尿病前期和糖尿病）的貢獻最大。

材料與方法：我們隨機招募了313名肥胖老年婦女。這四個因素是由我們小組發表的方程計算出來的。接收器操作特性（ROC）曲線用於計算曲線下面積（AUC）。建立了兩個模型：模型1：GE和FPIS，模型2：模型1 + SPIS。

結果：從最高到最低的四個因子的AUC分別是SPIS，FPIS，GE和IR（分別為0.722, 0.683, 0.681和0.534）。模型1的AUC（FPIS和GE）為0.732，高於SPIS。將SPIS添加到模型1後，模型2的AUC不會增加（0.731）。基於該模型1，建立了一個方程(p = -331✕GE - 0.003✕FPIS + 5.45)。如果p等於或高於零（≥ 0），則受試者有更高的機會出現葡萄糖失調（敏感性= 0.699，特異性= 0.636）。

結論：SPIS是老年肥胖中國女性血糖調節異常的最重要因素，其次是FPIS，GE和IR。通過建立GE和FPIS模型只能稍微增加預測能力。

 

Background: Old obese subjects are particularly vulnerable to the complications of type 2 diabetes. Insulin resistance (IR), glucose effectiveness (GE), first and second phase insulin secretion (FPIS, SPIS) are recognized as the pathophysiological factors for inducing diabetes. In the study, we estimated IR, FPIS, SPIS and GE to determine which one contributes most for having glucose dysregulation (prediabetes and diabetes).

Materials and methods: We randomly enrolled 313 obese old women. The four factors were calculated by the equations published by our groups. The receiver operating characteristic (ROC) curve was used to calculate the area under the curve (AUC). Two models were built: Model 1: GE and FPIS and Model 2: Model 1 + SPIS.

Results: The AUC of the four factors, from the highest to the lowest are SPIS, FPIS, GE and IR (0.722, 0.683, 0.681 and 0.534, respectively). The AUC of Model 1 (FPIS and GE) was 0.732 which is higher than that of SPIS. After adding the SPIS on to model 1, the AUC of model 2 does not increase (0.731). Based on this model 1, an equation was built (p = -331✕GE - 0.003✕FPIS + 5.45). If p is equal or higher than zero (≥ 0), the subject would have higher chance to have glucose dysregulation (sensitivity = 0.699, specificity = 0.636).

Conclusion: SPIS is the most important determinate for having glucose dysregulation followed by FPIS, GE and IR in old-obese Chinese women. By building a model with GE and FPIS could only modestly increase the prediction power.