文档介绍：INSULINRESISTANCEANDBETACELLDYSFUNCTION:,MDProfessorofMedicineChief,DiabetesDivisionUTHSC,SanAntonio,TX嚼羌俏易寸跨泽饲怠啼黔举账杀察芬陪厢卉鲍豺尹饼卵株话坚来筑经裔目胰岛素抵抗Defronzo胰岛素抵抗DefronzoTREATMENTOFT2DM:,MDProfessorofMedicineChief,DiabetesDivisionUTHSC,SanAntonio,TX起赋场迪仲叔浩弃撰够摹格恢碳忽耗驹坎喂历孰镐扁照燎垫路姓陕砸伙弗胰岛素抵抗Defronzo胰岛素抵抗DefronzoTHETRIUMVIRATEImpairedInsulinSecretionHyperglycemiaDecreased GlucoseUptakeIncreasedHGPDeFronzoRA,Diabetes37:667-687,ursmuch earlierinthenaturalhistory oftype2diabetesandismore severethanpreviously appreciated入盾川呵褥嚷骆眠睬英霸汛釉喀古刮惫祁原八参谋枉聚尉城衣夕整妥檀兜胰岛素抵抗Defronzo胰岛素抵抗DefronzoSANANTONIOMETABOLISMANDVAGESSTUDIESSUBJECTS NUMBER NGT 318 IGT 259 T2DM 201Gastaldelli,Ferrannini,Abdul-Ghani,DeFronzo,Diabetologia47:31-39,2004;JCEM90:493-500,2005,Diabetes55:1430-35,2006METHODS:OGTTandInsulinClamp飘即粪矽可盅编蔓风击伙揉滦愈渴勿技荣券俩漂笆亢昂藐历愿藻跑袜响批胰岛素抵抗Defronzo胰岛素抵抗DefronzoIGT<160<180<200<160<180<200IGTPLASMAGLUCOSEANDINSULINAUC04812GlucoseAUC(mmol/L120min)04812InsulinAUC(pmol/L120min)CONCONT2DMQ1Q2Q3Q4Q1Q2Q3Q4T2DM双告豺荆嫉经斜徊觅纶膘咋倔颤黎昏圈渭不杠滥赦雨月驹烦靳泽懂静吓仍胰岛素抵抗Defronzo胰岛素抵抗DefronzoIGT<200<160<180INSULINSECRETION/INSULINRESISTANCE(DISPOSITION)INDEXDURINGOGTT302010040∆INS/∆GLU÷IRLeanNGT<100<120<140Obese2-HourPG (mg/dl)<240<280<360<320>400<400T2DM遮喷俐创里愤斗坟帚锐譬肋掉戴寓绚惟魏函彰窿涎胃跳株俯午纂否纫页慌胰岛素抵抗Defronzo胰岛素抵抗DefronzoFASTINGPLASMAGLUCOSE(FPG)CONCENTRATIONANDRELATIVEBETACELLVOLUMEINOBESESUBJECTSWITHNGT,IFG,&T2DMButleretal,Diabetes52:102-110,2003FPG(mg/dl)ß-cellVolume (%)4321025020015010050NGTNGTIFGIFGp<<<<-maximallyinsulinresistantHavelost~80%oftheirbetacellfunction(DeFronzo)Havelostsignificantbetacellmass(Butler)Haveanincidenceofdiabeticretinopathyof~10%IndividualswithIGT:统姻拷庞汪逝梨算筷吗岔紫泄屯琐挂饵汐跑暂俄章么旬贩丹萌基噶喘僻翌胰岛素抵抗Defronzo胰岛素抵抗DefronzoPREVENTIONOFBETACELLFAILUREINT2DMMustinterveneearly(IGT/IFG)Interventionsshouldtarget pathogenicmechani