关键词: 糖尿病, 2型, 空腹血糖, 糖化血红蛋白, 胰岛素分泌, 影响因素分析

Abstract: Background　The ability of islets to secrete insulin in response to glucose could affect the long-term prognosis of newly diagnosed type 2 diabetes mellitus （T2DM），so studying the associated factors is of vital significance for clinical diagnosis and treatment of newly diagnosed T2DM.Objective　To explore the influencing factors of post-load peak insulin secretion （Imax） in newly diagnosed T2DM.Methods　411 newly diagnosed T2DM inpatients were recruited from Department of Endocrinology，Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from October 2015 to October 2019.Data were collected，including demographics and other observation indicators，blood glucose levels measured at 0，30，60，120，180 minutes（G0，G30，G60，G120，G180） during a 3-hour 75 g oral glucose tolerance test（OGTT），and insulin levels measured at 0，30，60，120，180 minutes（I0，I30，I60，I120 and I180） in a 3-hour insulin response test），and calculated first-phase insulin secretion index（ΔI30/ΔG30 ratio），HOMA-β，and HOMA-IR.The post-load peak blood glucose （Gmax） and Imax were obtained by polynomial curve fitting.By post-load Imax tertiles，the patients were divided into low Imax group （Imax<21.40 mU/L，n=137），medium Imax group （21.40 mU/L≤Imax<48.10 mU/L，n=137） and high Imax group （Imax≥48.10 mU/L，n=137）.The influencing factors of Imax was explored by multivariate Logistic regression.Results　BMI，ΔI30/ΔG30，HOMA-β and HOMA-IR increased with the increment of Imax （P<0.05）.G0，G30，G60，G120，G180，Gmax and HbA1c decreased with the increment of Imax （P<0.05）.Low Imax group had higher proportion of men，and lower prevalence of hypertension and non-alcoholic fatty liver disease than other two groups （P<0.05）.The prevalence of uricemia of high Imax group was higher than that of other groups （P<0.05）.The red blood cell count and hemoglobin of high Imax group were lower than those of low Imax group （P<0.05）.Spearman correlation analysis indicated that Imax was positively correlated with BMI，ΔI30/ΔG30，HOMA-β，and HOMA-IR （P<0.05），while was negatively correlated with G0，G30，G60，G120，G180，Gmax，HbA1c，red blood cell count and hemoglobin （P<0.05）.Multivariate logistic regression analysis showed that gender 〔OR=0.392，95%CI （0.192，0.803） 〕，hypertension 〔OR=1.745，95%CI （1.028，2.967） 〕，hyperuricemia 〔OR=2.801，95 %CI （1.408，5.587） 〕，G0 〔OR=0.679，95%CI （0.504，0.913）〕，G180 〔OR=0.875，95%CI （0.778，0.985）〕，HbA1c 〔OR=0.802，95%CI （0.688，0.935） 〕，ΔI30/ΔG30 〔OR=2.394，95%CI（1.725，3.322） 〕 and HOMA-IR 〔OR=1.829，95%CI（1.414，2.367）〕 were the influencing factors of Imax in patients with newly diagnosed T2DM （P<0.05）.Conclusion　Fasting blood glucose and HbA1c were negatively correlated with Imax for patients with newly diagnosed T2DM.Gender，hypertension，hyperuricemia，G0，G180，HbA1c，ΔI30/ΔG30 and HOMA-IR may be associated with Imax.Therefore，priority should be given to achieving the target level of HbA1c during glycemic control，which is contributive to improving the ability of islets to secrete insulin in response to glucose.

Key words: Diabetes mellitus, type 2；Fasting plasma glucose；Glycosylated hemoglobin；Insulin secretion；Root cause analysis