非洲成年新发 2 型糖尿病患者的胰岛素缺乏症。

Frontiers in clinical diabetes and healthcare Pub Date : 2022-07-28 eCollection Date: 2022-01-01 DOI:10.3389/fcdhc.2022.944483
Davis Kibirige, Isaac Sekitoleko, Priscilla Balungi, William Lumu, Moffat J Nyirenda
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引用次数: 0

摘要

确定新发 2 型糖尿病患者是否存在胰岛素缺乏症有助于及时进行胰岛素替代治疗。在这项研究中,我们测量了空腹 C 肽的浓度,以评估内源性胰岛素分泌情况,并确定了乌干达确诊 2 型糖尿病成年患者中胰岛素缺乏症患者的患病率和特征:从乌干达七家三级医院招募新发糖尿病成年患者。排除了三种胰岛自身抗体阳性的患者。对494名成年患者的空腹C肽浓度进行了测量,并将空腹C肽浓度定义为胰岛素缺乏:参与者的年龄、糖化血红蛋白(HbA1c)和空腹 C 肽的中位数(IQR)分别为 48 (39-58) 岁、10.4 (7.7-12.5) % 或 90 (61-113) mmol/mol 和 1.4 (0.8-2.1) ng/ml。108人(21.9%)存在胰岛素缺乏症。确诊为胰岛素缺乏症的参与者男性比例更高(53.7% 对 40.4%,P=0.01),体重指数或 BMI 更低(P=0.01)[结论:胰岛素缺乏症在这一人群中很普遍,大约每 5 名患者中就有 1 人存在胰岛素缺乏症。胰岛素缺乏症患者更有可能出现高 HbA1c,脂肪和代谢综合征的标志物也更少。这些特征应增加对胰岛素缺乏症的怀疑,并指导有针对性的检测和胰岛素替代疗法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Apparent Insulin Deficiency in an Adult African Population With New-Onset Type 2 Diabetes.

Identifying patients with new-onset type 2 diabetes who have insulin deficiency can aid in timely insulin replacement therapy. In this study, we measured fasting C-peptide concentration to assess endogenous insulin secretion and determine the prevalence and characteristics of patients with insulin deficiency in adult Ugandan patients with confirmed type 2 diabetes at presentation.

Methods: Adult patients with new-onset diabetes were recruited from seven tertiary hospitals in Uganda. Participants who were positive for the three islet autoantibodies were excluded. Fasting C-peptide concentrations were measured in 494 adult patients, and insulin deficiency was defined as a fasting C-peptide concentration <0.76 ng/ml. The socio-demographic, clinical, and metabolic characteristics of participants with and without insulin deficiency were compared. Multivariate analysis was performed to identify independent predictors of insulin deficiency.

Results: The median (IQR) age, glycated haemoglobin (HbA1c), and fasting C-peptide of the participants was 48 (39-58) years,10.4 (7.7-12.5) % or 90 (61-113) mmol/mol, and 1.4 (0.8-2.1) ng/ml, respectively. Insulin deficiency was present in 108 (21.9%) participants. Participants with confirmed insulin deficiency were more likely to be male (53.7% vs 40.4%, p=0.01), and had a lower body mass index or BMI [p<0.001], were less likely to be hypertensive [p=0.03], had reduced levels of triglycerides, uric acid, and leptin concentrations [p<0.001]), but higher HbA1c concentration (p=0.004). On multivariate analysis, BMI (AOR 0.89, 95% CI 0.85-0.94, p<0.001), non-HDLC (AOR 0.77, 95% CI 0.61-0.97, p=0.026), and HbA1c concentrations (AOR 1.08, 95% CI 1.00-1.17, p=0.049) were independent predictors of insulin deficiency.

Conclusion: Insulin deficiency was prevalent in this population, occurring in about 1 in every 5 patients. Participants with insulin deficiency were more likely to have high HbA1c and fewer markers of adiposity and metabolic syndrome. These features should increase suspicion of insulin deficiency and guide targeted testing and insulin replacement therapy.

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