Lancet子刊:中国大型队列研究助力糖尿病病因探索
  • 2011-12年纳入94952名40岁以上的成年人,随访至2016年,评估基线时自稳态情况(HOMA),包括胰岛素抵抗IR和β细胞功能障碍;
  • HOMA-IR上四分位者糖尿病风险增高6.7倍,而HOMA-β下四分位者,糖尿病风险增高4.08倍;
  • 约24.4%的新发糖尿病可归因于胰岛素抵抗,而有12.4%可归因于β细胞功能紊乱;
  • 在正常体重及肥胖者中,HOMA-IR及HOMA-β评分与糖尿病发病风险的关联存在差异,说明BMI在其中与HOMA存在交互作用。
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本研究由上海瑞金医院、国家临床内分泌与代谢疾病研究中心等多家单位合作开展的队列研究。研究发现在基线中胰岛素抵抗、胰岛β细胞功能障碍者,未来发生糖尿病的风险明显增高。且这种关联在基线糖耐量正常以及糖尿病早期的人群中均稳定存在。以往的观点认为,β细胞功能障碍是中国人2型糖尿病的主要发病机制,本研究则强调了肥胖在其中扮演的重要作用。有专家认为,中国人同时具备了较弱的β细胞功能,以及较高的肥胖患病率和伴随而来的胰岛素抵抗,从而给原本脆弱的β细胞功能增加“额外打击”,因此导致严重的糖尿病流行。
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Association of insulin resistance and β-cell dysfunction with incident diabetes among adults in China: a nationwide, population-based, prospective cohort study

中国成年人中胰岛素抵抗、β细胞紊乱与胰岛素发生的关系:一项基于人群的全国性前瞻性队列研究

10.1016/S2213-8587(19)30425-5

2019-12-23, Article

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Background: National investigations on the interaction of insulin resistance, β-cell dysfunction, and obesity with the development of diabetes are scarce in China. We aimed to investigate the individual and joint associations of insulin resistance and β-cell dysfunction with incident diabetes, and to examine the modifying effect of BMI and waist circumference on these associations among adults with normal glucose tolerance and with prediabetes.
Methods: In this nationwide, population-based, prospective cohort study, we analysed data from the China Cardiometabolic Disease and Cancer Cohort Study, which recruited adults aged 40 years or older during 2011–12 (baseline) and invited participants to attend follow-up visits in 2014–16. Patients with diabetes at baseline, missing data for baseline measures of glucose tolerance status, missing data for baseline homoeostasis model assessment (HOMA) indexes, missing data for baseline covariates, and missing data for measures of glucose tolerance status at follow-up visits were excluded. At baseline and follow-up visits, a comprehensive set of questionnaires, clinical measurements, oral glucose tolerance tests, and laboratory examinations were carried out following standardised protocols. Glucose tolerance status and prediabetes were defned according to the American Diabetes Association 2010 criteria. In the main analysis, we examined the contributions of insulin resistance (HOMA of insulin resistance [HOMA-IR]) and β-cell dysfunction (HOMA of β-cell function [HOMA-B]) to diabetes risk, and evaluated the impact of obesity on these associations
Findings: 94952 participants (31517 men and 63435 women) were included in the analysis. High HOMA-IR was associated with a greater hazard of diabetes (quartile 4 vs 1: hazard ratio [HR] 6·70, 95% CI 6·08–7·39; per unit increase in Z score: HR 2·17, 95% CI 2·10–2·24) than low HOMA-B (quartile 1 vs 4: 4·08, 3·72–4·48; per unit decrease in Z score: 1·92, 1·85–2·00). Approximately 24·4% (95% CI 23·6–25·2) of the incident diabetes could be attributed to insulin resistance and 12·4% (11·2–13·7) could be attributed to β-cell dysfunction. The HRs for diabetes were 1·83 (95% CI 1·72–1·95) per unit increase in Z score of HOMA-IR and 2·03 (1·86–2·21) per unit decrease in Z score of HOMA-B among participants with normal weight; the corresponding HRs for diabetes were 2·02 (1·93–2·11) and 1·88 (1·79–1·98) among participants with obesity (pinteraction =0·0091). These associations and interactions were similar for participants with normal glucose tolerance or prediabetes.
Interpretation: Insulin resistance shows a stronger association with incident diabetes than does β-cell dysfunction in Chinese adults, and this association pattern was more prominent among adults with obesity. Given the limitations of HOMA indexes as surrogate measures of insulin resistance and β-cell dysfunction, these fndings should be interpreted with caution.

First Authors:
Tiange Wang,Jieli Lu,Lixin Shi,Gang Chen,Min Xu,Yu Xu

Correspondence Authors:
Weiqing Wang

All Authors:
Tiange Wang,Jieli Lu,Lixin Shi,Gang Chen,Min Xu,Yu Xu,Qing Su,Yiming Mu,Lulu Chen,Ruying Hu,Xulei Tang,Xuefeng Yu,Mian Li,Zhiyun Zhao,Yuhong Chen,Li Yan,Guijun Qin,Qin Wan,Meng Dai,Di Zhang,Zhengnan Gao,Guixia Wang,Feixia Shen,Zuojie Luo,Yingfen Qin,Li Chen,Yanan Huo,Qiang Li,Zhen Ye,Yinfei Zhang,Chao Liu,Youmin Wang,Shengli Wu,Tao Yang,Huacong Deng,Jiajun Zhao,Shenghan Lai,Yufang Bi,Ralph A DeFronzo,Weiqing Wang,Guang Ning,China Cardiometabolic Disease and Cancer Cohort Study Group

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