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정상내당능인 비만 소아청소년의 인슐린 예민도와 베타세포기능

Insulin Sensitivity and Beta Cell Function in Obese Korean Children and Adolescents with Normal Glucose Tolerance

최인경|김덕희|김교순|정소정
대한소아내분비학회 (Korean Society Of Pediatric Endocrinology)|2010.04|Annals of Pediatric Endocrinology & Metabolism|제15권 제1호|pp. 19-25

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Insulin resistancePrediabetic state
주제분류소아과학

초록

목 적: 비만의 급증으로 대사증후군 및 당뇨병의 위험이 증가하였으며 인슐린저항성의 평가가 요구되고 있다. 인슐린 저항성과 인슐린 분비능력저하는 2형 당뇨병의 주 위험요소이며 특히 한국인 성인의 2형 당뇨병 초기병인으로 인슐린 분비능력저하가 중요하다고 보고되었다. 그러나 침습적인 검사법으로 인해 소아에서의 인슐린 저항성 및 분비능력 평가는 제한적으로 시행되고 있다. 본 연구에서는 정상내당능을 보인 비만인 소아 및 청소년을 대상으로 인슐린 예민도와 베타세포기능을 알아보고자 하였다. 방 법: 신체검진결과 비만으로 확인되어 당부하검사를 시행 후 정상내당능으로 확인된 총 250명(남/녀 165/85, 평균연령 12.0±2.7세)을 대상으로 하였다. 혈당, 인슐린농도 및 총콜레스테롤, 중성지방, LDL-콜레스테롤, HDL-콜레스테롤치를 분석에 사용하였다. 내당능장애가 있는 경우는 대상에서 제외하였다. 120분 혈당치 4분위수에 따라서 4군으로 나누었다. 인슐린 예민도의 지표로는 whole-body insulin sensitivity index (WBISI)를, 베타세포기능의 지표로는 insulinogenic index (IGI)를 사용하였다. WBISI와 IGI로 hyperbolic feedback curve를 작성하였다. 결 과: 4군간의 연령, 성별, 신장, 체중 및 체질량지수의 유의한 차이는 없었다. 4군간의 공복혈당의 유의한 차이는 없었으나 당부하검사상 혈당 변화의 유의한 차이가 있었다. 120분 혈당의 증가에 따라 공복 인슐린 및 120분 인슐린의 유의한 증가가 있었다. 120분 혈당의 증가에 따라 IGI의 유의한 차이는 없었다. 120분 혈당의 증가에 따라 WBISI의 유의한 감소가 있었다. 120분 혈당의 증가에 따라 hyperbolic feedback curve상 유의한 왼쪽편향이 있었다. 결 론: 경구당부하검사 결과 정상내당능을 나타내는 비만아에서는 120분 혈당이 증가할수록 인슐린 저항성이 증가하고 인슐린 분비능력은 감소하는 경향이 연속적으로 진행되어 내당능장애 내지 당뇨병으로 이행된다는 가능성을 시사하여 추후 관찰이 필요하다고 생각한다.

Abstract

Purpose: Obesity and insulin resistance are well known risk factors of type 2 diabetes. Impaired fasting glucose and impaired glucose tolerance (IGT) are called prediabetes and considered as a spectrum of disease and the insulin secretory function and insulin sensitivity are an emerging important issues. The aim of this study was to investigate the beta cell function and insulin sensitivity in Korean obese children who have normal glucose tolerance (NGT). Methods: The data from two hundred fifty children and adolescents (M/F 165/85, age 12.0±2.7) were included. Fasting glucose, insulin, total cholesterol, triglyceride, LDL-cholesterol, HDL-choldesterol and oral glucose tolerance test (OGTT) results were analyzed. In this study, insulinogenic index (IGI) and whole body insulin sensitivity index (WBISI) were calculated from oral glucose tolerance test as markers of insulin secretory function and insulin sensitivity. Subjects were divided into 4 groups by glucose level in 120min (Glu120m) quartiles. Hyperbolic feedback curves were drawn with IGI and WBISI. Results: 1) Height, weight, age, sex and BMI were not significantly different among 4 groups. 2) Fasting glucose levels among 4 groups were not significantly different. 3) HOMA-IR was significantly different according to Glu120m. 4) WBISI was significantly decreased according to Glu120m. 5) Leftward shift toward IGT in the feedback curve was significant in higher Glu120m groups. Conclusion: Obese children with high normal levels in oral glucose tolerance test may have a gradual deterioration in glucose stimulated insulin response and have an increased risk of IGT and diabetes. More mechanistic studies for the transition from NGT to IGT and ultimately diabetes should be followed.

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