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目的:拟基于体质指数(body mass index,BMI),研究胰岛素抵抗(insulin resistance,IR)及胰岛素分泌受损(impaired insulin secretion,IIS)和2型糖尿病(type 2 diabetes mellitus,T2DM)发病率的关系。方法:为期5年的队列研究共纳入未患T2DM的参与者2 857名,并根据BMI对其进行分组(BMI<23.0,23.0~24.9和≥25.0)。然后,基于胰岛素生成指数和稳态模型中IR值将每组BMI参与者进一步细分为:正常、只有IIS(isolated IIS,i-IIS)、只有IR(isolated IR,i-IR)和同时有IIS和IR(IIS plus IR,IIS+IR)人群。结果:BMI<23.0组中,i-IIS和IIS+IR人群患T2DM的风险明显高于正常人,其风险比(hazard ratios,HRs)及95%置信区间(confidence interval,CI)分别为6.21(3.44,9.75)和8.01(2.85,25.34);BMI(23.0~24.9)组中,i-IIS[HRs=8.50(3.91,19.67)]、i-IR[HRs=3.16(1.13,8.43)]和IIS+IR[HRs=20.31(8.74,53.28)]人群患T2DM的风险明显高于正常人;BMI≥25.0组中,i-IIS[HRs=15.58(5.44,44.73)]、i-IR[HRs=7.78(2.56,22.41)]和IIS+IR[HRs=23.25(8.47,74.68)]人群患T2DM的风险明显高于正常人。BMI与IIS(相关系数r=-0.45,P=0.032)和IR(r=0.61,P=0.010)的发生率分别呈负相关及正相关。结论:BMI<23.0的人群更可能因IIS患T2DM,而BMI≥23.0的人群则更可能因IR患T2DM。
Objective: To study the incidence of insulin resistance (IR) and impaired insulin secretion (IIS) and type 2 diabetes mellitus (T2DM) based on body mass index (BMI) relationship. METHODS: A total of 2 857 participants without T2DM were enrolled in the five-year cohort study and were grouped according to BMI (BMI <23.0, 23.0-24.9 and ≥25.0). Then, each BMI participant was further subdivided into three groups based on the insulin production index and the IR value in the steady-state model: normal, only IIS (isolated IIS, i-IIS), only IR IIS and IR (IIS plus IR, IIS + IR) crowd. Results: In BMI <23.0 group, the risk of T2DM in i-IIS and IIS + IR patients was significantly higher than that in normal subjects, and the hazard ratios (HRs) and 95% confidence interval (CI) I-IIS [HRs = 8.50 (3.91,19.67)], i-IR [HRs = 3.16 (1.13,8.43)] and IIS + IR [HRs = 20.31 (8.74,53.28)], the risk of T2DM was significantly higher in the population than in the normal subjects; i-IIS [HRs = 15.58 (5.44,44.73)], i-IR [HRs = 7.78 (2.56, 22.41)] and IIS + IR [HRs = 23.25 (8.47, 74.68)] were significantly higher in the population with T2DM than in normal individuals. The incidences of BMI and IIS (correlation coefficient r = -0.45, P = 0.032) and IR (r = 0.61, P = 0.010) were negatively correlated and positively correlated. Conclusion: People with BMI <23.0 are more likely to develop T2DM due to IIS, whereas those with BMI ≥ 23.0 are more likely to develop T2DM due to IR.