1. Journal Club 埼玉医科大学 総合医療センター 内分泌・糖尿病内科 Department of Endocrinology and Diabetes, Saitama Medical Center, Saitama Medical University 松田 昌文 Matsuda, Masafumi 2014 年 6 月 26 日 8:30-8:55 ８階 医局 Winner D1, Norton L, Kanat M, Arya R, Fourcaudot M, Hansis-Diarte A, Tripathy D, Defronzo RA, Jenkinson CP, Abdul-Ghani M. Strong Association Between Insulin-Mediated Glucose Uptake and the 2-Hour, Not the Fasting Plasma Glucose Concentration in the Normal Glucose Tolerance Range. J Clin Endocrinol Metab. 2014 May 5:jc20132886. [Epub ahead of print]

2. http://dx.doi.org/10.1210/jc.2013-2886

3. Aim: to examine the relationship between whole body insulin-mediated glucose disposal and the fasting plasma glucose concentration in non-diabetic individuals.

4. Research Design and Methods: 253 non-diabetic subjects with NGT, IFG, IGT and CGI received 75-gram OGTT and euglycemic hyperinsulinemic clamp. Total glucose disposal (TGD) during the insulin clamp was compared in IFG and NGT individuals and was related to fasting and 2- h plasma glucose concentrations in each group.

9. To further examine the contribution of 2h PG vs FPG concentration to the variability in TGD, we created a multiple linear regression model with TGD as the dependent variable and FPG and 2h-PG concentrations as independent variables. After adjustment for age, gender, BMI, and steady state plasma insulin concentration (SSPI) during the last hour of the clamp, only SSPI, BMI and 2h PG concentration were significant independent predictors of insulin- stimulatedTGD(Table 2), and this model explained 50% of the variance in TGD. Each 10 mg/dl increase in 2h PG concentration was associated with 0.423 mg/kg.min decrease in TGD. Conversely, a 5 mg/dl increase in the FPG concentration was associated with a small (0.08 mg/ kg.min), nonsignificant increase in TGD.

10. Results: TGD varied considerably between NGT and IFG individuals and displayed a strong inverse relationship with the 2h PG (r=0.40, p<0.0001) but not with the FPG. When IFG and NGT individuals were stratified based upon their 2-h PG concentration, the increase in 2h-PG was associated with a progressive decrease in TGD in both groups, and the TGD was comparable among NGT and IFG individuals.

11. Conclusion: the present results indicate that: (i) as in NGT, insulin-stimulated TGD varies considerably in IFG individuals; (ii) the large variability in TGD in IFG and NGT individuals is related to the 2h-PG concentration; (iii) after adjustment for the 2h PG concentration, IFG subjects have comparable TGD to NGT individuals.

12. Message 未だに血糖の設定値についてなぞが多いようであ る。 空腹時血糖値は TGD とは関連なさそう。 ( ただし インスリン値について隠している。 ) 負荷後２時間血糖値は ( 筋肉の ) インスリン感受性 と関連。 ( インスリン分泌低下の役割は？ ) 糖尿病はしたがって筋肉のインスリン感受性低 下？？？