目的了解中老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者少肌性肥胖(sarcopenic obesity,SO)患病率及不同诊断方法之间的一致性。方法采用系统随机抽样法选取2016年1月至2018年3月于北京地区9家医院内分泌科就诊的≥50岁T2DM患者,使用生物阻抗法进行身体成分检测;根据2022年欧洲临床营养与代谢学会(European Society for Clinical Nutrition and Metabolism,ESPEN)和欧洲肥胖研究协会(European Association for the Study of Obesity,EASO)方法定义SO,另外3种方法通过肌少症和肥胖的组合进行诊断。肌少症使用2019年亚洲肌少症工作组(Asian Working Group for Sarcopenia,AWGS)建立的标准来定义,肥胖通过体脂(percent of body fat,PBF)、腰围(waist circumference,WC)和体质量指数(body mass index,BMI)来定义。卡方检验进行率的比较,Cohens kappa统计分析比较4种方法的诊断一致性。结果共纳入1125例T2DM受试者,男性586例,年龄[61.2(55.3,67.4)]岁;女性539例,年龄[62.0(56.3,68.1)岁]。使用ESPEN/EASO共识、AWGS+PBF、AWGS+WC和AWGS+BMI标准,中老年T2DM患者SO患病率分别为41.6%、20.4%、30.1%和18.8%。4种方法之间的诊断一致性存在异质性(κ:0.109~0.655)。ESPEN/EASO共识与AWGS+PBF诊断一致性良好(κ:0.655),AWGS+体脂与AWGS+BMI诊断一致性良好(κ:0.637),AWGS+WC与AWGS+BMI(κ:0.359)、与AWGS+PBF诊断一致性中等(κ:0.330)。结论中老年T2DM患者SO患病率高,患病率和诊断一致性在不同诊断方法中存在差异,ESPEN/EASO的共识诊断率最高,AWGS+BMI诊断率最低,ESPEN/EASO共识与AWGS+体脂具有良好的诊断一致性。
目的:比较口服葡萄糖耐量试验(OGTT)诊断的糖调节受损(IGR)和糖化血红蛋白(HbA 1c)定义的糖尿病前期(PreDM)人群的临床特征。方法:本研究为横断面研究。2019年7至11月在北京市延庆区招募符合成人糖尿病高危人群定义且未接受过任何干预的受试者402例。分别用75 g OGTT和HbA 1c评估糖代谢状态,测量身高、体重、收缩压(SBP)、舒张压(DBP),检测空腹血糖(FPG)、负荷后2 h血糖(2 h PG)、空腹胰岛素(FINS)、负荷后2 h胰岛素(2 h INS)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)等。计算体质指数(BMI)、稳态模型评估β细胞功能指数(HOMA-β)、稳态模型评估胰岛素抵抗指数(HOMA-IR)、Matsuda指数等。根据2019年美国糖尿病学会标准分为IGR组和HbA 1c定义的PreDM组,比较两组间各临床指标的差异。两组间比较采用独立样本t检验或Mann-Whitney U检验,多组间比较采用单因素方差分析或Kruskal-Wallis H检验。计数资料比较采用χ2检验。结果:排除5例血红蛋白<110 g/L的受试者,共有397例受试者进行糖代谢状态评估。根据OGTT诊断IGR 161例(40.6%),根据HbA 1c诊断PreDM 188例(47.4%)。与IGR组相比,PreDM组BMI[(28.7±9.2)和(26.1±3.7)kg/m 2,t=-3.335,P<0.01]和Matsuda指数[4.64(3.21,6.89)和4.08(2.85,5.95),Z=-2.443,P<0.05]更高,FPG[(5.7±0.5)和(5.9±0.6)mmol/L,t=3.611,P<0.01]、2 h PG[(7.4±1.9)和(8.7±1.6)mmol/L,t=6.757,P<0.01]及2 h INS[(56.8±45.7)和(69.3±50.5)mIU/L,t=2.418,P<0.05]更低,SBP、DBP、FINS、HbA 1c、TG、TC、LDL-C、HDL-C、HOMA-β及HOMA-IR差异无统计学意义(均P>0.05)。进一步分析显示,与IGR但HbA 1c<5.7%亚组相比,单纯符合PreDM亚组中2 h PG和2 h INS更低、HbA 1c更高(均P<0.05),BMI、SBP、DBP、FPG、FINS、TG、TC、LDL-C、HDL-C、HOMA-β、HOMA-IR及Matsuda指数差异无统计学意义(均P>0.05)。结论:IGR与HbA 1c定义的PreDM两组人群之间,不仅血糖变化谱有所不同,而且BMI、胰岛素敏感性、胰岛β细胞功能等指标也存在差异。
Objective To determine the relationships of Met416Val and XbaI polymorphism of muscle glycogen synthase (GYS1) gene and Trg64Arg variant of the β 3 adrenergic receptor (β 3 AR) gene with type 2 diabetes mel...
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Objective To determine the relationships of Met416Val and XbaI polymorphism of muscle glycogen synthase (GYS1) gene and Trg64Arg variant of the β 3 adrenergic receptor (β 3 AR) gene with type 2 diabetes mellitus (DM) and its intermediate phenotypes in the Chinese population Methods Polymerase chain reaction oligonucleotide ligation assay and restriction fragment length polymorphism assay were used to evaluate the GYS1 and β 3 AR gene polymorphisms in 102 pairs of case control Chinese spouses Results Subjects with Met416Val variant had a significantly higher 2 hour post glucose level than subjects without this variant had in diabetic group ( P =0 032) The Met416Val polymorphism of GYS1 gene was not significantly associated with the risk of type 2 DM (adjusted OR=1 67; 95% CI: 0 73-3 81, P =0 223) Subjects with Trp64Arg variant had a significantly higher serum uric acid level than subjects without this variant had in diabetic group ( P =0 034) The combination of BMI and Arg64 allele carrier of the β 3 AR gene increased the diabetic risk over four fold (adjusted OR=4 00; 95%CI: 1 53-10 45, P =0 005) Conclusions In the Chinese population, Met416Val polymorphism is identified in a subgroup of diabetic subjects with high 2 hour post glucose It will explain why some diabetic patients appear to be genetically predisposed to developing high postpradial glucose level The presence of the Arg64 allele in the β 3 AR gene may predispose patients to higher serum uric acid level
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