Predictors of and longitudinal changes in insulin sensitivity and secretion preceding onset of type 2 diabetes

被引:268
作者
Lyssenko, V [1 ]
Almgren, P
Anevski, D
Perfekt, R
Lahti, K
Nissén, M
Isomaa, B
Forsen, B
Homström, N
Saloranta, C
Taskinen, MR
Groop, L
Tuomi, T
机构
[1] Lund Univ, Univ Hosp MAS, Dept Endocrinol, Wallenberg Lab, S-20502 Malmo, Sweden
[2] Fraunhofer Chalmers Ctr, Gothenburg, Sweden
[3] Vasa Hlth Care Ctr, Vaasa, Finland
[4] Vasa Cent Hosp, Vaasa, Finland
[5] Jakobstad Hosp, Pietarsaari, Finland
[6] Narpes Care Hlth Ctr, Narpes, Finland
[7] Korsholm Hlth Care Ctr, Korsholm, Finland
[8] Helsinki Univ Hosp, Dept Med, FIN-00170 Helsinki, Finland
[9] Folkhalsan Res Ctr, Helsinki, Finland
关键词
D O I
10.2337/diabetes.54.1.166
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Identification of individuals at high risk of developing type 2 diabetes is a prerequisite for prevention of the disease. We therefore studied risk factors predicting type 2 diabetes in the Botnia Study in western Finland. A total of 2,115 nondiabetic individuals were prospectively followed with repeated oral glucose tolerance tests. After a median follow-up of 6 years, 127 (6%) subjects developed diabetes. A family history of diabetes (hazard ratio [HR) 2.2, P = 0.008), BMI (HR for comparison of values below or above the median 2.1, P < 0.001), waist-to-height index (2.3, P < 0.001), insulin resistance (2.1, P = 0.0004), and beta-cell function adjusted for insulin resistance (2.7, P < 0.0001) predicted diabetes. Marked deterioration in beta-cell function with modest changes in insulin sensitivity was observed during the transition to diabetes. The combination of FPG greater than or equal to 5.6 mmolA, BMI greater than or equal to30 kg/m(2), and family history of diabetes was a strong predictor of diabetes (3.7, P < 0.0001). Of note, using FPG greater than or equal to6.1 mmol/1 or 2-h glucose greater than or equal to7.8 mmol/; did not significantly improve prediction of type 2 diabetes. In conclusion, a marked deterioration in beta-cell function precedes the onset of type 2 diabetes. These individuals can be identified early by knowledge of FPG, BMI, and family history of diabetes.
引用
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页码:166 / 174
页数:9
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