β‐Cell function in postmenopausal women with isolated post‐challenge hyperglycemia

• Published in: Journal of diabetes Vol. 10; no. 2; pp. 158 - 165
• Main Authors: Hwu, Chii‐Min, Lin, Yi‐Chun, Lin, Kuan‐Hung
• Format: Journal Article
• Language: English
• Published: Melbourne Wiley Publishing Asia Pty Ltd 01.02.2018; John Wiley & Sons, Inc
• Subjects: Biomarkers - analysis; Blood Glucose - analysis; Diabetes; diabetes mellitus; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - metabolism; Fasting; Female; Follow-Up Studies; Glucose; Glucose Intolerance - diagnosis; Glucose Intolerance - metabolism; Glucose Tolerance Test; Humans; Hyperglycemia; Hyperglycemia - physiopathology; Insulin; Insulin - metabolism; Insulin Resistance; Insulin Secretion; Insulin-Secreting Cells - metabolism; Middle Aged; Postmenopause; postprandial hyperglycemia; Prognosis; Womens health; 糖尿病; 绝经后; 胰岛素; 餐后高血糖; postprandial hyperglycemia; insulin; 绝经后; 餐后高血糖; diabetes mellitus; 胰岛素; postmenopause; 糖尿病
• ISSN: 1753-0393; 1753-0407; 1753-0407
• DOI: 10.1111/1753-0407.12571

Background Isolated post‐challenge hyperglycemia (IPH) is an early stage of type 2 diabetes mellitus (T2DM), with fasting glucose <126 mg/dL and 2‐h glucose ≥200 mg/dL. Observations of insulin secretion profile in subjects with IPH may provide an insight into the pathogenesis of T2DM in older women. Methods We recruited 555 naturally postmenopausal women without a history of T2DM to the present study. All participants received a 75‐g oral glucose tolerance test to determine whether they had IPH. General linear models were used to compare differences in glucose metabolism among subjects. Results Early phase insulin responses to oral glucose were significantly decreased in women with IPH versus those with impaired glucose tolerance (IGT) and normal glucose tolerance (geometric mean [95% confidence interval] insulinogenic index 61 [54–79] vs 90 [83–97] and 105 [96–116], respectively; P  < 0.0001). In addition, there were significant decreases in late‐phase insulin release as metabolic status shifted from normal glucose tolerance to IGT to IPH. In the present cohort, the relative contribution of early insulin secretion to 2‐h glucose was no longer significant ( P  = 0.15) after multiple factors, including indicators of insulin resistance and late‐phase insulin release, were entered into the regression model simultaneously. Conclusions The results demonstrate that postmenopausal women with IPH are characterized by impaired β‐cell function. There were significant decreases in early and late‐phase insulin release as glucose intolerance escalated. Disturbance in β‐cell function seems to be an important factor associated with early T2DM in postmenopausal women. 摘要 背景 单纯餐后高血糖(isolated post‐challenge hyperglycemia,  IPH)是2型糖尿病的早期阶段,  其空腹血糖低于126 mg/dL,  但口服75 g葡萄糖水2小时后的血糖大于或等于200 mg/dL。通过观察IPH患者的胰岛素分泌特点,  有助于了解老年妇女2型糖尿病的发病机理。 方法 本研究纳入555位无糖尿病病史的自然停经后妇女,  所有受检者均接受口服75 g葡萄糖耐糖试验以诊断是否有IPH。利用统计的一般线性模型,  比较不同受试者之间的血糖代谢差异。 结果 与糖耐量减退(impaired glucose tolerance,  IGT)组以及对照组相比,  IPH妇女口服葡萄糖后诱发的早期胰岛素分泌显著下降,  胰岛素分泌指数的平均值为61 [95%置信区间:54‐79],  IGT妇女为90 [95%置信区间:83‐97],  正常妇女则为105 [95%置信区间:96‐116] (P < 0.0001)。此外,  不同妇女的晚期胰岛素分泌也随代谢状态从糖耐量正常到IGT到IPH的转变而降低。在本研究中,  若将胰岛素抵抗和晚期胰岛素分泌指标等多种因素共同导入统计回归模型,  那么早期胰岛素分泌对2小时血糖的相对贡献度则不再显著(P = 0.15)。 结论 本研究显示,  罹患IPH的绝经后妇女的血糖代谢特征表现为β细胞功能受损。随着糖耐量减退的逐步加剧,  早期和晚期胰岛素分泌功能也明显下降。β细胞功能紊乱似乎是绝经后妇女罹患早期2型糖尿病的重要因素。 Highlights Isolated post‐challenge hyperglycemia (IPH) is a common feature in women after menopause. Across the spectrum of glucose tolerance, there were significant decreases in early and late‐phase insulin release as metabolic status shifted from normal glucose tolerance to impaired glucose tolerance to IPH in the present study. Disturbance in β‐cell function seems to be an important factor associated with early diabetes mellitus in postmenopausal women.