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目的：研究糖尿病不同发展阶段胰岛素敏感性及胰岛素分泌功能的改变，指导2 型糖尿病的早期诊断。方法：57 例行OGTT 体检者，分为NGT、IGT、IFG+IGT、新诊断T2DM 四组，并行IVGTT，采用HOMA-IR 评估胰岛素敏感性，采用葡萄糖处置指数 [DI1= HOMA-β/HOMA-IR，DI2=ΔI30/ΔG30/HOMA-IR，DI3=MBCI×IAI，DI4= AIR0-10/HOMA-IR]及AUCINS/HOMA-IR 评估胰岛素分泌功能。结果：IGT、IFG+IGT、新诊断T2DM 组HOMA-IR 无统计学差异（P>0.05），均显著高于NGT 组（P<0.05）。IGT、 IFG+IGT、新诊断T2DM 组DI1 逐步降低（P<0.05）；NGT、IGT 组DI1 无统计学差异（P>0.05）。NGT、IGT、IFG+IGT、新诊断T2DM 组DI2、DI3、DI4 逐步降低（P<0.05）。IFG+IGT、新诊断T2DM 组OGTTAUCINS/HOMA-IR 逐步降低（P<0.05）,且显著低于NGT 组（P<0.05）；NGT、IGT 组OGTTAUCINS/HOMA-IR 无统计学差异（P>0.05）。结论：（1）IGT 阶段胰岛素抵抗及胰岛素1 相、早期相分泌功能的下降同时存在。IFG+IGT 阶段胰岛素1 相、早期相分泌进一步下降，并出现基础相、2 相分泌的减少，胰岛素抵抗加重不明显。新诊断T2DM 阶段胰岛素各相分泌进一步减少，胰岛素抵抗加重不明显。（2）在T2DM 发生过程中，胰岛素分泌功能下降较胰岛素敏感性下降更为明显。（3）胰岛素抵抗及胰岛素1 相、早期相分泌功能的下降是T2DM 的预测因子。（4）IFG+IGT 阶段应积极干预。

英文摘要:

Objective: To guide the early diagnosis of type 2 diabetes mellitus (T2DM) by investigating the differences of insulin secretion and insulin sensitivity at differert stages from nomal glucose tolerance (NGT) to T2DM. Methods: A total of 57 Chinese adults were divided into NGT, isolated impaired glucose tolerance (IGT), combined impaired fasting glucose and impaired glucose tolerance (IFG plus IGT), and newly-diagnosed T2DM according to oral glucose tolerance test (OGTT), then were given to an intravenous glucose tolerance test (IVGTT) and insulin release test. Insulin sensitivity was measured by homeostasis model assessment of insulin resistance (HOMA-IR); The islet β-cell function was evaluated by disposition indices[DI1=HOMA-β/Homa-IR, DI2=ΔI30/ΔG30/Homa-IR, DI3= MBCI×IAI, DI4= AIR0-10/Homa-IR] and insulin area under curve of OGTT (AUCINS) /Homa-IR. Results: HOMA-IR in IGT、IFG plus IGT and newly-diagnosed T2DM groups were significantly higher than that of NGT (P<0.05), but there was no significant difference among IGT、IFG plus IGT and newly-diagnosed T2DM (P>0.05). DI1 was gradually decreased from IGT through IFG plus IGT to newly-diagnosed T2DM (P<0.05)，but there was no significant difference between NGT and IGT(P>0.05). DI2, DI3, DI4 were gradually decreased from NGT through IGT, IFG plus IGT to newly-diagnosed T2DM (P<0.05). but there was no significant difference between NGT and IGT (P>0.05). OGTTAUCINS/HOMA-IR was gradually decreased from IFG plus IGT to newly-diagnosed T2DM (P<0.05)，but there was no significant difference between NGT and IGT (P>0.05). Conclusions:(1) Insulin resistance and the decline of first-phase, early-phase of insulin secretion existed in IGT at the same time. The decline of first-phase, early-phase of insulin secretion aggravated in IFG plus IGT, and impairment of basic-phase,second-phase of insulin secretion occurred, but the decrease of insulin sensitivity was not obvious. The dysfunction of all phase of insulin secretion existed in newly-diagnosed T2DM, but the decrease of insulin sensitivity was also not obvious. (2) β-cell function defection may play more important role during the development of T2DM. (3)Insulin sensitivity,firstphase and early-phase insulin secretion were predict factors of T2DM. (4) IFG plus IGT needed active intervention .

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