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인슐린 비의존형 당뇨병 환자의 직계자식에서 당수송체 유전자의 다형성과 인슐린 분비능 및 말초조직의 포도당 이용율 등의 대사적 측면과의 상호연관성에 관한 연구
이현철(Hyun Chul Lee),이영식(Young Sik Lee),박석원(Seog Won Park),정윤석(Yoon Sok Chung),안광진(Kwang Jin Ahn),이은직(Eun Jig Lee),임승길(Sung Kil Lim),김경래(Kyung Rae Kim),허갑범(Kap Bum Huh),김태연(Tae Yeun Kim),임정수(Jung Soo Rh 대한내과학회 1993 대한내과학회지 Vol.45 No.1
N/A Background: First-degree relatives of non-insulin dependent diabetes mellitus are generally accepted to be high risk group for development of non-insulin dependent diabetes mellitus. So we are intended to identify the early metabolic defects in the young first-degree relatives of non-insulin dependent diabetes mellitus. Methods: Ten offsprings of non-insulin dependent diabetes mellitus and ten healthy men were included in this study. They were all third decade male subjects and matched well with age and body mass indices. Both groups were not different in anthropometric measurements (IBW, BMI, WHR), dilay calorie intake and total energy consumptions (total energy expenditure, physical activity). Results: 1) Oral glucose tolerance test showed normal responses of plasma glucose levels and C-peptide levels in both groups. 2) There were statistically significant differences (p<0.05) in plasma glucose, C-peptide and insulin levels at 60 minutes between two groups (Glucose 100±19 vs. 77±19mg/dl; C-peptide 5.47±1.7 vs. 3.32±1.88ng/ml; Insulin 90.3±41.3 vs. 38.6±29.4 μU/ml). 3) The result of euglycemic hyperinsulinemic clamp study showed that offsprings of non-insulin dependent diabetes mellitus had significantly diminished rates of insulin-mediated glucose disposal compared to the control group (5.61±1.01 vs. 8.87±0.92mg/kg B.W/min, p<0.01). 4) Simple linear regression analysis showed a good correlation between peripheral glucose utilization rates and the lean mass composition measured by body composition analyzer (Futrex-5000, Futrex Co., USA). As the lean mass percentage increases, peripheral glucose utilization rate also increases with positive 1inear relationship (r2=0.49, p<0.05). 5) By the method of restriction fragment length polymorphism, we found two polymorphic Kpn I sites of 6.5 kb and 5.8 kd as described previously without any new polymorphism for GLUT4 gene DNA in both groups. We also used other two restriction endonucleases, Bam HI and Eco RI, but did not discover polymorphism at GLUT4 gene locus. Conclusion: This study supports the genetic tendency of non-insulin dependent diabetes mellitus and showed that the early metabolic defect in the young offsprings is expressed as insulin resistance rather than pancreatic beta-cell dysfunction, The insulin resistance is in the negative linear relationship with the lean mass composition and seems to arise from the skeletal muscle tissue. For preventing the development of glucose intolerant status and overt diabetes, the avoidance of obesity and maintenance of muscle mass by means of careful diet control and continuous exercise program may be helpful.
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