<strong>Background: </strong>Progressive insulin resistance (IR) is an important pathophysiologic mechanism of gestational diabetes mellitus (GDM). Homeostatic model assessment (HOMA) is commonly used as a...<strong>Background: </strong>Progressive insulin resistance (IR) is an important pathophysiologic mechanism of gestational diabetes mellitus (GDM). Homeostatic model assessment (HOMA) is commonly used as a parameter of the severity of insulin resistance. <strong>Aims:</strong> To determine indices of insulin resistance (IR) and <em>β</em>-cell function in gestational diabetes mellitus (GDM). <strong>Methods:</strong> This cross sectional study was conducted from March 2017 to September 2018 at Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (B中央人民政府), Dhaka, Bangladesh. The study was performed with 41 GDM and equal number of pregnant women with normal glucose tolerance (NGT) diagnosed on basis of WHO criterion-2013 during 24 - 40 weeks of gestation. Serum glucose was measured by glucose oxidase method and fasting serum insulin was measured by chemiluminescent immunoassay. Equations of homeostatic model assessment (HOMA) were used to calculate insulin indices like-insulin resistance (HOMA-IR), <em>β</em>-cell function (HOMA-B) and insulin sensitivity (HOMA-%S). Data were analyzed and compared by statistical tests. <strong>Results: </strong>A total of eighty-two (82) subjects [41 women with GDM (age: 28.29 ± 3.79 years, BMI: 27.16 ± 4.13 kg/m2) and 41 women with NGT (age: 26.22 ± 5.13 years, BMI: 25.27 ± 3.01 kg/m2)] were included in this study. It was observed that GDM women were significantly older (p = 0.041) and had significantly higher BMI (p = 0.020) than pregnant women with NGT. The GDM group had significantly higher IR as indicated by higher fasting insulin value [GDM vs. NGT;10.19 (7.71 - 13.34) vs. 6.88 (5.88 - 8.47) μIU/ml, median (IQR);p = 0.001] and HOMA-IR [GDM vs. NGT;2.31 (1.73 - 3.15) vs. 1.42 (1.15 - 1.76), median (IQR);p < 0.001], poor <em>β</em>-cell secretory capacity [GDM vs. NGT;HOMA-B: 112.63 (83.52 - 143.93) vs. 128.60 (108.77 - 157.58), median (IQR);p = 0.04] and low insulin sensitivity [GDM vs. NGT;HOMA-%S: 43.29 (31.77 - 57.98) vs. 70.42 (56.86 - 86.59), median (IQR);p < 0.001]. Conclusions: GDM is associated with both insulin resistance and inadequate insulin secretion.展开更多
Introduction: In recent years, flow mediated dilatation (FMD) has become a popular technique in cardiovascular medicine. HOMA-IR was accepted to determine the insulin sensitivity as a valuable standard. In this study,...Introduction: In recent years, flow mediated dilatation (FMD) has become a popular technique in cardiovascular medicine. HOMA-IR was accepted to determine the insulin sensitivity as a valuable standard. In this study, we evaluated the association between HOMA-IR (homeostasis model assessment of insulin resistance) and vascular endothelial dysfunction, as assessed by endothelium- dependent flow-mediated dilatation (FMD) and nitroglycerin-mediated dilatation (NMD), in type 2 Diabetic (DM) patients. Material and Methods: Eighty four (84) consecutive out-patients were enrolled. HOMA-IR was calculated as fasting insulin (μU/ml) multiplied by fasting plasma glucose (FPG) (mg/dl) and divided by 405. The ultrasound method for measuring FMD and NMD has been used. Out of 84 patients, 42 patients were in control group and 42 patients were in diabetic group, which were further subdivided into two groups based on HOMA-IR > 3.0 and above was considered as Group I and HOMA IR < 3.0 and below was considered as Group II. Fasting Plasma Glucose (mmol/dl) (7.74 ± 2.56, 6.81 ± 1.9, p < 0.001) and Fasting Insulin (μU/dl) (13.26 ± 8.09, 6.65 ± 2.36, p < 0.001) were statistically significant in Group I. The baseline mean FMD in controls and cases (Group I and Group II) was 15.36 ± 9.56, 4.15 ± 2.29, 12.21 ± 6.24 (p < 0.001) respectively. By logistic regression analysis the factors which were effective on FMD percentage change (<5.5%) in Group I were BMI (p < 0.02), plasma Insulin (p < 0.04) and triglycerides (p < 0.02). There was a negative co-relation for FMD, NMD and HOMA-IR. Discussion: We conclude that increased HOMA-IR in hyperglycaemic patients is associated with severe endothelial dysfunction which is the marker of the atherosclerosis. Thus the measurement of endothelial vasomotor function which is a comprehensive analysis of atherosclerotic burden may provide a better predictive value of future cardiovascular events than the analysis of each of the traditional risk factors alone.展开更多
目的研究脂联素(adiponectin,ADPN)对妊娠期糖尿病(gestational diabetes mellitus,GDM)的早期预测效能,探索GDM早期诊断的新指标及早期预测的风险模型。方法选取2023年7月至11月于首都医科大学附属北京同仁医院建档的486例孕妇在孕早期...目的研究脂联素(adiponectin,ADPN)对妊娠期糖尿病(gestational diabetes mellitus,GDM)的早期预测效能,探索GDM早期诊断的新指标及早期预测的风险模型。方法选取2023年7月至11月于首都医科大学附属北京同仁医院建档的486例孕妇在孕早期(孕7~12周)组成队列,并根据2010年国际糖尿病与妊娠研究组(International Association for Diabetes and Pregnancy Study Group,IADPSG)推荐的GDM诊断标准,将孕中期妊娠妇女分为GDM组(150例)和非GDM组(336例)。收集孕早期ADPN、胰岛素(insulin,INS)、空腹血糖(fasting glucose,GLU)及糖化白蛋白(glycated albumin,GA)等数据,计算脂联素-胰岛素抵抗指数(homeostatic model assessment of adiponectin,HOMA-AD)、胰岛素抵抗指数(homeostatic model assessment of insulin resistance index,HOMA-IR)及肝脂肪变性指数(hepatic steatosis index,HSI)。分析比较两组之间ADPN、HOMA-AD、HOMA-IR等差别,采用受试者工作特征(receiver operating characteristics,ROC)曲线分析各类指标预测GDM的价值,并结合相关指标建立预测风险模型。结果GDM组和非GDM组妇女孕早期ADPN差异具有统计学意义(P<0.05)。ROC曲线分析结果显示,ADPN早期预测GDM阳性的曲线下面积(area under the curve,AUC)为0.723,截断值为13.38 mg/L。GDM组和非GDM组的HOMA-AD差异具有统计学意义(P=0.000)。HOMA-AD早期预测GDM的AUC为0.815,截断值为3.024。将GLU、HOMA-AD、HOMA-IR、HSI纳入风险模型,结果显示Logistic模型各方面较好,最终测试集AUC=0.829,准确度=0.740,灵敏度=0.913,阴性预测值=0.833。结论GDM组妇女的ADPN及HOMA-AD水平相较于非GDM组均降低,且HOMA-AD与GDM呈现负相关,在早期预测GDM的效能优于ADPN、HOMA-IR、HSI,HOMA-AD可以联合这些指标建立诊断预测模型提高预测效能。展开更多
目的探讨脂蛋白(a)水平与2型糖尿病患者胰岛素抵抗之间的相关性,揭示其在糖尿病代谢调控中的潜在作用。方法采用单中心横断面研究设计,纳入106例2型糖尿病患者,根据脂蛋白(a)水平分为高水平组(脂蛋白(a)>100mg/dL)与低水平组(脂蛋白...目的探讨脂蛋白(a)水平与2型糖尿病患者胰岛素抵抗之间的相关性,揭示其在糖尿病代谢调控中的潜在作用。方法采用单中心横断面研究设计,纳入106例2型糖尿病患者,根据脂蛋白(a)水平分为高水平组(脂蛋白(a)>100mg/dL)与低水平组(脂蛋白(a)≤100 mg/dL)。收集一般信息及实验室指标,包括脂蛋白(a)、空腹血糖(fasting plasma glucose,FPG)、空腹胰岛素(fasting insulin,FINS)等,及计算胰岛素抵抗稳态模型评估指数(Homeo-stasis Model Assessment of Insulin Resistance,HOMA-IR)。通过Spearman相关分析评估脂蛋白(a)与HOMA-IR的相关性,采用多元线性回归模型控制混杂因素后验证两者的独立关系。结果高水平脂蛋白(a)组的HOMA-IR显著低于低水平组(P=0.036)。相关性分析显示,脂蛋白(a)水平与HOMA-IR呈负相关(r=-0.26,P=0.0066)。回归分析表明,调整年龄、性别、身体质量指数(BodyMassIndex,BMI)等混杂因素后,脂蛋白(a)水平仍与HOMA-IR显著负相关(β=-0.00996,P=0.0267)。结论脂蛋白(a)水平可能是2型糖尿病患者胰岛素抵抗的独立预测因子,较高的脂蛋白(a)水平与改善的胰岛素敏感性相关。展开更多
文摘<strong>Background: </strong>Progressive insulin resistance (IR) is an important pathophysiologic mechanism of gestational diabetes mellitus (GDM). Homeostatic model assessment (HOMA) is commonly used as a parameter of the severity of insulin resistance. <strong>Aims:</strong> To determine indices of insulin resistance (IR) and <em>β</em>-cell function in gestational diabetes mellitus (GDM). <strong>Methods:</strong> This cross sectional study was conducted from March 2017 to September 2018 at Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (B中央人民政府), Dhaka, Bangladesh. The study was performed with 41 GDM and equal number of pregnant women with normal glucose tolerance (NGT) diagnosed on basis of WHO criterion-2013 during 24 - 40 weeks of gestation. Serum glucose was measured by glucose oxidase method and fasting serum insulin was measured by chemiluminescent immunoassay. Equations of homeostatic model assessment (HOMA) were used to calculate insulin indices like-insulin resistance (HOMA-IR), <em>β</em>-cell function (HOMA-B) and insulin sensitivity (HOMA-%S). Data were analyzed and compared by statistical tests. <strong>Results: </strong>A total of eighty-two (82) subjects [41 women with GDM (age: 28.29 ± 3.79 years, BMI: 27.16 ± 4.13 kg/m2) and 41 women with NGT (age: 26.22 ± 5.13 years, BMI: 25.27 ± 3.01 kg/m2)] were included in this study. It was observed that GDM women were significantly older (p = 0.041) and had significantly higher BMI (p = 0.020) than pregnant women with NGT. The GDM group had significantly higher IR as indicated by higher fasting insulin value [GDM vs. NGT;10.19 (7.71 - 13.34) vs. 6.88 (5.88 - 8.47) μIU/ml, median (IQR);p = 0.001] and HOMA-IR [GDM vs. NGT;2.31 (1.73 - 3.15) vs. 1.42 (1.15 - 1.76), median (IQR);p < 0.001], poor <em>β</em>-cell secretory capacity [GDM vs. NGT;HOMA-B: 112.63 (83.52 - 143.93) vs. 128.60 (108.77 - 157.58), median (IQR);p = 0.04] and low insulin sensitivity [GDM vs. NGT;HOMA-%S: 43.29 (31.77 - 57.98) vs. 70.42 (56.86 - 86.59), median (IQR);p < 0.001]. Conclusions: GDM is associated with both insulin resistance and inadequate insulin secretion.
文摘Introduction: In recent years, flow mediated dilatation (FMD) has become a popular technique in cardiovascular medicine. HOMA-IR was accepted to determine the insulin sensitivity as a valuable standard. In this study, we evaluated the association between HOMA-IR (homeostasis model assessment of insulin resistance) and vascular endothelial dysfunction, as assessed by endothelium- dependent flow-mediated dilatation (FMD) and nitroglycerin-mediated dilatation (NMD), in type 2 Diabetic (DM) patients. Material and Methods: Eighty four (84) consecutive out-patients were enrolled. HOMA-IR was calculated as fasting insulin (μU/ml) multiplied by fasting plasma glucose (FPG) (mg/dl) and divided by 405. The ultrasound method for measuring FMD and NMD has been used. Out of 84 patients, 42 patients were in control group and 42 patients were in diabetic group, which were further subdivided into two groups based on HOMA-IR > 3.0 and above was considered as Group I and HOMA IR < 3.0 and below was considered as Group II. Fasting Plasma Glucose (mmol/dl) (7.74 ± 2.56, 6.81 ± 1.9, p < 0.001) and Fasting Insulin (μU/dl) (13.26 ± 8.09, 6.65 ± 2.36, p < 0.001) were statistically significant in Group I. The baseline mean FMD in controls and cases (Group I and Group II) was 15.36 ± 9.56, 4.15 ± 2.29, 12.21 ± 6.24 (p < 0.001) respectively. By logistic regression analysis the factors which were effective on FMD percentage change (<5.5%) in Group I were BMI (p < 0.02), plasma Insulin (p < 0.04) and triglycerides (p < 0.02). There was a negative co-relation for FMD, NMD and HOMA-IR. Discussion: We conclude that increased HOMA-IR in hyperglycaemic patients is associated with severe endothelial dysfunction which is the marker of the atherosclerosis. Thus the measurement of endothelial vasomotor function which is a comprehensive analysis of atherosclerotic burden may provide a better predictive value of future cardiovascular events than the analysis of each of the traditional risk factors alone.
文摘目的研究脂联素(adiponectin,ADPN)对妊娠期糖尿病(gestational diabetes mellitus,GDM)的早期预测效能,探索GDM早期诊断的新指标及早期预测的风险模型。方法选取2023年7月至11月于首都医科大学附属北京同仁医院建档的486例孕妇在孕早期(孕7~12周)组成队列,并根据2010年国际糖尿病与妊娠研究组(International Association for Diabetes and Pregnancy Study Group,IADPSG)推荐的GDM诊断标准,将孕中期妊娠妇女分为GDM组(150例)和非GDM组(336例)。收集孕早期ADPN、胰岛素(insulin,INS)、空腹血糖(fasting glucose,GLU)及糖化白蛋白(glycated albumin,GA)等数据,计算脂联素-胰岛素抵抗指数(homeostatic model assessment of adiponectin,HOMA-AD)、胰岛素抵抗指数(homeostatic model assessment of insulin resistance index,HOMA-IR)及肝脂肪变性指数(hepatic steatosis index,HSI)。分析比较两组之间ADPN、HOMA-AD、HOMA-IR等差别,采用受试者工作特征(receiver operating characteristics,ROC)曲线分析各类指标预测GDM的价值,并结合相关指标建立预测风险模型。结果GDM组和非GDM组妇女孕早期ADPN差异具有统计学意义(P<0.05)。ROC曲线分析结果显示,ADPN早期预测GDM阳性的曲线下面积(area under the curve,AUC)为0.723,截断值为13.38 mg/L。GDM组和非GDM组的HOMA-AD差异具有统计学意义(P=0.000)。HOMA-AD早期预测GDM的AUC为0.815,截断值为3.024。将GLU、HOMA-AD、HOMA-IR、HSI纳入风险模型,结果显示Logistic模型各方面较好,最终测试集AUC=0.829,准确度=0.740,灵敏度=0.913,阴性预测值=0.833。结论GDM组妇女的ADPN及HOMA-AD水平相较于非GDM组均降低,且HOMA-AD与GDM呈现负相关,在早期预测GDM的效能优于ADPN、HOMA-IR、HSI,HOMA-AD可以联合这些指标建立诊断预测模型提高预测效能。
文摘目的探讨脂蛋白(a)水平与2型糖尿病患者胰岛素抵抗之间的相关性,揭示其在糖尿病代谢调控中的潜在作用。方法采用单中心横断面研究设计,纳入106例2型糖尿病患者,根据脂蛋白(a)水平分为高水平组(脂蛋白(a)>100mg/dL)与低水平组(脂蛋白(a)≤100 mg/dL)。收集一般信息及实验室指标,包括脂蛋白(a)、空腹血糖(fasting plasma glucose,FPG)、空腹胰岛素(fasting insulin,FINS)等,及计算胰岛素抵抗稳态模型评估指数(Homeo-stasis Model Assessment of Insulin Resistance,HOMA-IR)。通过Spearman相关分析评估脂蛋白(a)与HOMA-IR的相关性,采用多元线性回归模型控制混杂因素后验证两者的独立关系。结果高水平脂蛋白(a)组的HOMA-IR显著低于低水平组(P=0.036)。相关性分析显示,脂蛋白(a)水平与HOMA-IR呈负相关(r=-0.26,P=0.0066)。回归分析表明,调整年龄、性别、身体质量指数(BodyMassIndex,BMI)等混杂因素后,脂蛋白(a)水平仍与HOMA-IR显著负相关(β=-0.00996,P=0.0267)。结论脂蛋白(a)水平可能是2型糖尿病患者胰岛素抵抗的独立预测因子,较高的脂蛋白(a)水平与改善的胰岛素敏感性相关。
