关键词: 糖尿病, 2型；血糖；胰岛素；葡糖耐量试验

Abstract: Objective　To discuss the relationship between fasting plasma glucose （FPG） and peak insulin level （INSmax） after glucose load in type 2 diabetes mellitus （T2DM） patients.Methods　We selected 548 hospitalized patients with T2DM from Department of Endocrinology，Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from January 2016 to February 2018.According to INSmax，we divided them into low INSmax group（INSmax≤30.0 mU/L，n=183），medium INSmax group（30.0 mU/L<INSmax≤62.5 mU/L，n=182），and high INSmax group（INSmax>62.5 mU/L，n=183）．We collected their clinical data，HbA1c and serum ketone bodies levels，routine blood test results，FPG，30，60，120，180 min blood glucose （GLU） levels （GLU levels measured at 30，60，120，180 min during a 3-hour 75 g oral glucose tolerance test） and fasting insulin （FIns） and 30，60，120，180 min INS levels （INS levels measured at 30，60，120，180 min during a 3-hour insulin response test），the time during which INS was at its peak （tmax），peak GLU level after glucose load （GLUmax） and the time during which GLU was at its peak （tmax），and calculated maximum INS level after glucose load （INSmeasuremax），homeostasis model assessment （HOMA）-β，HOMA-insulin resistance （IR），and the difference between tmax and Tmax （ΔT）．Results　Compared with low INSmax group，both medium and high INSmax groups showed lower male ratio，lower HbA1c level and lower incidence of ketosis but higher use rate of external insulin，higher prevalence of hypertension history，hyperuricemia/gout history，hyperlipidemia history，non-alcoholic fatty liver disease history as well as higher average body mass index （BMI） （P<0.01）．High INSmax group had greater red blood cell distribution width compared with low INSmax group，and lower HbA1c and hemoglobin （Hb） compared with medium INSmax group（P<0.01）．In comparison with other two groups，low INSmax group demonstrated higher FPG and 30，60，120，180 min GLU，GLUmax，Tmax and lower FIns as well as 30，60，120，180 min INS （P<0.05）．Moreover，it presented greater GLUmax and Tmax and less INSmeasuremax，HOMA-β，HOMA-IR and ΔT （P<0.05）．The FPG，30，60，120，180 min GLU and GLUmax was lower while FIns，30，60，120，180 min INS，INSmeasuremax，HOMA-β，HOMA-IR and ΔT were higher in the high INSmax group compared with those of the medium INSmax group（P<0.05）．INSmax was positively correlated with BMI，eosinophils，FIns，30，60，120，180 min INS，HOMA-β，HOMA-IR，INSmeasuremax，and ΔT （P<0.05），but negatively correlated with HbA1c，Hb，FPG，30，60，120，180 min GLU，GLUmax and Tmax （P<0.05）．Multivariate Logistic regression analysis showed that INSmax increased with the growth of HOMA-IR，and with the decrease of FPG and 180 min GLU（P<0.001）．Conclusion　FPG is negatively correlated with INSmax in patients with T2DM，so FPG control is of great significance for improving the secretory reserve of pancreatic islet β-cells.

Key words: Diabetes mellitus, type 2；Blood glucose；Insulin；Glucose tolerance test