The Effects of Aging on Glucose Metabolism

老化對葡萄糖代謝的影響

施翔蓉(Shyang-Rong Shih) ； 曾慶孝(Chin-Hsiao Tseng)

《台灣老年醫學暨老年學雜誌》 4卷1期 (2009/02) Pp. 27-38

https://doi.org/10.29461/TGG.200902.0003

摘要

第2型糖尿病是老年人最常見的慢性新陳代謝性疾病。葡萄糖失耐症和糖尿病的盛行率和發生率皆隨著年齡的增加而上升。在台灣的流行病學研究中發現，糖尿病的盛行率隨年齡增加而上升，65歲老人糖尿病盛行率約為20%；糖尿病發生率在小於35歲民眾約為每年每十萬人口中有9.3人，在65歲以上民眾約為每年每十萬人口中有725.8人。導致年齡相關的葡萄糖耐受性不佳原因包括了β細胞功能變差與胰島素敏感性下降。β細胞功能變差的原因可能與葡萄糖毒性和粒線體功能障礙相關，而粒線體功能障礙可能與老化引起之控制粒線體複製的基因突變有關。胰島素敏感性下降的原因可能與粒線體功能障礙和肌肉三酸甘油酯增加有關；肌細胞中三酸甘油酯的水解間接地可能會活化蛋白分解酶C (protein kinase C)，進而影響胰島素下游訊息的傳遞，即降低胰島素敏感性。其他可能的相關因子包括胰島素受器數量減少、AMP-刺激蛋白酶(AMP-activated protein kinase, AMPK)活性減低、脂締素(adiponectin)減少和瘦素(leptin)增加。但這些致病機轉都還需要進一步研究來證實。找出關鍵的影響因子，才能發展出有效的治療方式。

關鍵字

老化 ； 葡萄糖耐性不良 ； 糖尿病 ； 胰島素敏感性 ； 胰島素阻抗性

並列摘要

Type 2 diabetes mellitus is the most common chronic metabolic disease/disorder in the elderly. The prevalence and incidence of impaired glucose tolerance and diabetes mellitus increase with aging. In Taiwan, the prevalence of diabetes mellitus increases with age and is approximately 20% in those aged 65 years or older. The incidence of diabetes mellitus is also increasing in Taiwan. In an epidemiologic study which showed an average incidence of 9.3 per 100,000 population in those aged ＜35 and 725.8 per 100,000 population in those aged ≥65 years. Responsible mechanisms of age-related glucose intolerance include decreased insulin sensitivity and decreased β-cell function. Decreased β-cell function may be related to glucotoxicity and mitochondrial dysfunction. Insulin resistance is related to mitochondrial dysfunction and increased intramyocytic triglyceride. Decreased number of insulin receptors, decreased AMP-activated protein kinase (AMPK) activity, decreased adiponectin and increased leptin are other postulated factors. Further studies are necessary to examine these hypotheses, to find out the key afflicting factors, and to work up as the target.

並列關鍵字

aging ； glucose intolerance ； diabetes mellitus ； insulin sensitivity ； insulin resistance