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目的:探讨运动加饮食干预对肥胖的2型糖尿病(T2DM)患者胰岛素抵抗(IR)及血清脂联素(ADP)水平的影响。方法:选取肥胖(BMI≥28kg/m2)患者106例,按美国糖尿病学会(ADA)2009年2型糖尿病诊断标准将患者分为糖尿病组(DM组)46例和非糖尿病组(即糖耐量正常、非DM组)60例。测定空腹血糖(FBG)、空腹胰岛素(FINS)、血脂[甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、ADP,计算胰岛素抵抗指数(HOMA-IR)及体质指数(BMI)。予DM组为期8周运动干预及饮食控制治疗,8周后再次检测上述指标。结果:(1)干预前DM组FBG、FINS、HOMA-IR、TG、LDL-C水平显著高于非DM组,ADP水平显著低于非DM组,差异均有统计学意义(P<0.05)。Spearman线性相关分析显示,HOMA-IR与年龄、TG呈正相关(均P<0.05),与ADP水平呈负相关(P<0.05)。(2)干预后DM组BMI、FBG、HOMA-IR高于非DM组,而ADP水平低于非DM组,差异均有统计学意义(P<0.05);且DM组FINS、TG、LDL-C、BMI水平较干预前下降,差异有统计学意义(P<0.05);Spearman线性相关分析表明:ADP水平与肥胖、FBG水平呈负相关(均P<0.05)。结论:肥胖的T2DM患者存在低ADP及高HOMA-IR,运动及饮食干预能有效降低T2DM患者血脂、ADP水平,改善胰岛素抵抗。
Objective: To investigate the effects of exercise and diet intervention on insulin resistance (IR) and serum adiponectin (ADP) level in obese type 2 diabetic patients (T2DM). Methods: One hundred and sixty patients with obesity (BMI≥28kg / m2) were divided into two groups according to the American Diabetes Association (ADA) diagnostic criteria of type 2 diabetes in 2009: 46 cases of diabetes mellitus (DM group) and non-diabetic group , Non-DM group) 60 cases. Fasting blood glucose (FBG), fasting insulin (FINS), triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) , ADP, calculated insulin resistance index (HOMA-IR) and body mass index (BMI). To the DM group for 8 weeks of exercise intervention and diet control treatment, again after 8 weeks to detect the above indicators. Results: (1) The levels of FBG, FINS, HOMA-IR, TG and LDL-C in DM group before intervention were significantly higher than those in non-DM group and ADP was significantly lower than those in non-DM group (P <0.05) . Spearman linear correlation analysis showed that HOMA-IR was positively correlated with age and TG (all P <0.05), and negatively correlated with ADP (P <0.05). (2) After intervention, the BMI, FBG and HOMA-IR in DM group were higher than those in non-DM group, while the levels of ADP in DM group were lower than those in non-DM group (P <0.05) (P <0.05). Spearman linear correlation analysis showed that ADP level was negatively correlated with obesity and FBG level (all P <0.05). Conclusion: Obesity T2DM patients with low ADP and high HOMA-IR, exercise and diet intervention can effectively reduce the level of blood lipid and ADP in T2DM patients and improve insulin resistance.