Chromium Improves Glucose Uptake and Metabolism Through Upregulating the mRNA Levels of IR,GLUT4, GS,and UCP3 in Skeletal Muscle Cells

The aim of this study was to evaluate the impact of three different chromium forms as chromic chloride (CrCl), chromium picolinate (CrPic), and a newly synthesized complex of chromium chelated with small peptides (CrSP) on glucose uptake and metabolism in vitro. In cultured skeletal muscle cells, chromium augmented insulin-stimulated glucose uptake and metabolism as assessed by a reduced glucose concentration of culture medium. At the molecular level, insulin significantly increased the mRNA levels of insulin receptor (IR), glucose transporter 4 (GLUT4), glycogen synthase (GS), and uncoupling protein-3 (UCP3), and these impacts can be enhanced by the addition of chromium, especially in the form of CrSP. Collectively, results of this study demonstrate that chromium improves glucose uptake and metabolism through upregulating the mRNA levels of IR, GLUT4, GS, and UCP3 in skeletal muscle cells, and CrSP has higher efficacy on glucose uptake and metabolism compared to the forms of CrCl and CrPic.     

Effects of short-term chromium supplementation on insulin sensitivity and body composition in overweight children: randomized, double-blind, placebo-controlled study

Excessive body weight is inversely associated with insulin sensitivity in children and adults. Chromium supplementation produces modest improvement in insulin sensitivity in adults. The aim of this study was to examine the beneficial effects of chromium supplementation on insulin sensitivity and body composition in overweight children simultaneously modifying lifestyle. Twenty-five overweight children aged 9–12 years were randomized to receive either 400 μg of chromium chloride or placebo in double-blind fashion, during a 6-week lifestyle modification regimen that included nutritional education and 3×90 min of aerobic physical activity weekly. Insulin sensitivity was demonstrated using homeostasis model assessment-insulin resistance and quantitative insulin sensitivity check index (QUICKI). Changes in body mass index (BMI; kg/m²), BMI Z-score, waist circumference, body composition and fasting plasma glucose were measured. Although no significant benefit of chromium supplementation over placebo was evident for BMI, BMI Z-score and fasting insulin level, children who received chromium chloride demonstrated more positive changes versus the placebo group in HOMA (−1.84±1.07 vs. 0.05±0.42, P=.05), QUICKI (0.02±0.01 vs. −0.002±0.01, P=.05), lean body mass (2.43±0.68kg vs. 1.36±1.61kg, P=.02) and percentage body fat (−3.32±1.29% vs. 0.65±1.05%, P=.04). The desirable effects of chromium supplementation on insulin sensitivity and body composition were more apparent in pre-pubertal children. These results suggest that short-term chromium supplementation can improve insulin sensitivity and body composition in overweight children.     

Chromium Improves Protein Deposition Through Regulating the mRNA Levels of IGF-1, IGF-1R,and Ub in Rat Skeletal Muscle Cells

The aim of this study was to evaluate the impact of three different chromium forms—chromic chloride (CrCl₃), chromium picolinate (CrPic), and a newly synthesized complex of chromium chelated with small peptides (CrSP)—on protein metabolism in vitro. In cultured skeletal muscle cells, CrSP was able to increase the basal and insulin-stimulated levels of protein deposition in skeletal muscles cells. CrCl₃ and CrPic augmented insulin-stimulated protein synthesis. At the molecular level, insulin significantly increased the mRNA levels of insulin-like growth factor 1 and insulin-like growth factor 1 receptor. These impacts could be enhanced by the addition of chromium, especially CrSP. The mRNA levels of ubiquitin were significantly reduced when cells were cultured with chromium or/and insulin. Assuming that the mRNA level increase or decrease results in increased or decreased levels of these proteins, chromium would improve protein anabolism and reduce protein catabolism and then prove protein deposition in rat skeletal muscle cells.     

Type 2 Diabetic Rats on Diet Supplemented With Chromium Malate Show Improved Glycometabolism,Glycometabolism-Related Enzyme Levels and Lipid Metabolism

Our previous study showed that chromium malate improved the regulation of blood glucose in mice with alloxan-induced diabetes. The present study was designed to evaluate the effect of chromium malate on glycometabolism, glycometabolism-related enzymes and lipid metabolism in type 2 diabetic rats. Our results showed that fasting blood glucose, serum insulin level, insulin resistance index and C-peptide level in the high dose group had a significant downward trend when compared with the model group, chromium picolinate group and chromium trichloride group. The hepatic glycogen, glucose-6-phosphate dehydrogenase, glucokinase, Glut4, phosphor-AMPKβ1 and Akt levels in the high dose group were significantly higher than those of the model, chromium picolinate and chromium trichloride groups. Chromium malate in a high dose group can significantly increase high density lipoprotein cholesterol level while decreasing the total cholesterol, low density lipoprotein cholesterol and triglyceride levels when compared with chromium picolinate and chromium trichloride. The serum chromium content in chromium malate and chromium picolinate group is significantly higher than that of the chromium trichloride group. The results indicated that the curative effects of chromium malate on glycometabolism, glycometabolism-related enzymes and lipid metabolism changes are better than those of chromium picolinate and chromium trichloride. Chromium malate contributes to glucose uptake and transport in order to improved glycometabolism and glycometabolism-related enzymes.     

Chromium and vanadate combination increases insulin-induced glucose uptake by 3T3-L1 adipocytes

Insulin activates signaling pathways in target tissues through the insulin receptor and Tyr phosphorylation of intracellular proteins. Vanadate mimics insulin and enhances its actions through inhibition of protein Tyr phosphatases. Chromium is a micronutrient that enhances insulin action to normalize blood glucose, but the mechanism is not understood. Here we show that either vanadate or chromium stimulates Tyr phosphorylation of insulin receptor in mouse 3T3-L1 adipocytes compared to insulin alone, but a combination of vanadate and chromium is not additive. Phosphorylation of MAPK or 4E-BP1 as markers for insulin signaling is stimulated by vanadate plus insulin, and chromium does not enhance the effects. Vanadate robustly activates glucose uptake by 3T3-L1 adipocytes even without added insulin and increases insulin-stimulated glucose uptake. Chromium pretreatment of adipocytes slightly enhances glucose uptake in response to insulin, but significantly increases glucose uptake above that induced by insulin plus vanadate. These data show that chromium enhances glucose uptake even when Tyr phosphorylation levels are elevated by vanadate plus insulin, suggesting separate mechanisms of action for vanadate and chromium.     

Efficacy of Chromium(III) Supplementation on Growth,Body Composition,Serum Parameters,and Tissue Chromium in Rats

Chromium(III) is often claimed to have a positive effect on body composition, while the responses in researches with supplementation of different chemical form of chromium are various and inconsistent. We have studied the effects of 6 weeks of treatment with three different forms of chromium (300 μg/kg) as chromium chloride, chromium tripicolinate, and chromium nanocomposite (CrNano) on growth, body composition, serum parameters, and tissue chromium in rats. The supplementataion of CrNano significantly increased average daily gain, food efficiency, and lean body mass and decreased fat mass and body fat proportion and serum levels of glucose, urea nitrogen, triglyceride, and insulin. Chromium contents in liver, kidney, and hind leg muscle were increased significantly with the addition of CrNano in diet. The results indicate that chromium nanocomposite has higher efficacy on growth and body composition compared to the traditional chromium agents.     

Chromium in metabolic and cardiovascular disease.

Chromium is an essential mineral that appears to have a beneficial role in the regulation of insulin action, metabolic syndrome, and cardiovascular disease. There is growing evidence that chromium may facilitate insulin signaling and chromium supplementation therefore may improve systemic insulin sensitivity. Tissue chromium levels of subjects with diabetes are lower than those of normal control subjects, and a correlation exists between low circulating levels of chromium and the incidence of type 2 diabetes. Controversy still exists as to the need for chromium supplementation. However, supplementation with chromium picolinate, a stable and highly bioavailable form of chromium, has been shown to reduce insulin resistance and to help reduce the risk of cardiovascular disease and type 2 diabetes. Since chromium supplementation is a safe treatment, further research is necessary to resolve the confounding data. The existing data suggest to concentrate future studies on certain forms as chromium picolinate and doses as at least 200 mcg per day.     

Chromium supplementation in non-obese non-diabetic subjects is associated with a decline in insulin sensitivity

The use of chromium supplements is widespread for the prevention and treatment of diabetes mellitus but there are conflicting reports on efficacy, possibly reflecting discrepant effects across different populations. In the present studies, we test the hypothesis that chromium supplementation raises serum chromium levels and correspondingly improves insulin sensitivity. A double blind placebo-controlled randomized trial was conducted on 31 non-obese, normoglycemic subjects. After baseline studies, the subjects were randomized to placebo or chromium picolinate 500 μg twice a day. The primary endpoint was change in insulin sensitivity as measured by euglycemic hyperinsulinemic clamp. Pre-specified secondary endpoints included fasting lipids, blood pressure, weight, body composition measured by DXA scan. After 16 weeks of chromium picolinate therapy there was no significant change in insulin sensitivity between groups (p=0.83). There was, however, a strong association between serum chromium and change in insulin resistance (β = -0.83, p=0.01), where subjects with the highest serum chromium had a worsening of insulin sensitivity. This effect could not be explained by changes in physiological parameters such as body weight, truncal fat and serum lipids with chromium therapy. Chromium therapy did not improve insulin sensitivity in non-obese normoglycemic individuals. Further, subjects who have high serum chromium levels paradoxically had a decline in insulin sensitivity. Caution therefore should be exercised in recommending the use of this supplement. The study was registered on the NIH registry (clinicaltrials.gov) and the identifier is NCT00846248     

Effect of Chromium-Enriched Yeast on Fasting Plasma Glucose, Glycated Haemoglobin and Serum Lipid Levels in Patients with Type 2 Diabetes Mellitus Treated with Insulin

Chromium is required for a normal insulin function, and low levels have been linked with insulin resistance. The aim of this study was to follow the effect of chromium supplementation on fasting plasma glucose (FPG), glycated haemoglobin (HbA_1c) and serum lipids in patients with type 2 diabetes mellitus (DM2) on insulin therapy. Eleven randomly selected patients with DM2 on insulin therapy were supplemented with a daily dose of 100 μg chromium yeast for the first supplementation period of 2 weeks. In the second supplementation period, the chromium dose was doubled and continued for the next 6 weeks. The third phase was a 6-week washout period. After each period, the levels of FPG and HbA_1c were compared with the corresponding values at the end of the previous period. Serum triglycerides, total HDL and LDL cholesterol values after supplementation were compared with the baseline values. FPG decreased significantly after the first period of chromium supplementation (p?<?0.001), and a tendency to a further reduction was observed after the second supplementation period. Similarly, HbA_1c decreased significantly in both periods (p?<?0.02 and p?<?0.002, respectively). Eight weeks after withdrawal of chromium supplementation, both FPG and HbA_1c levels returned to their pre-intervention values. The serum lipid concentrations were not significantly influenced by chromium supplementation. Chromium supplementation could be beneficial in patients with DM2 treated with insulin, most likely due to lowered insulin resistance leading to improved glucose tolerance. This finding needs to be confirmed in a larger study.     

Interaction between diazepam and oral antidiabetic agents on serum glucose,insulin and chromium levels in rats

This study was undertaken to investigate the effect of diazepam in the presence and absence of glibenclamide, metformin or their combination on serum levels of glucose, insulin and chromium in rats. Results indicated that diazepam (10 mg/kg i.p.) induced marked hyperglycaemic effects in hyperglycaemic rats. This effect was associated with significant reductions in serum chromium levels and insignificant reduction in serum insulin levels. Diazepam-induced hyperglycaemia was counter-acted by concurrent administration of glibenclamide (5 mg/kg orally), metformin (500 mg/kg orally) or their combination. The effect of diazepam on serum chromium level was counteracted partially by administration of glibenclamide and augmented in the presence of metformin or its combination with glibenclamide. It is concluded that the diazepam-induced hyperglycaemia, as well as the hypoglycaemic effect of glibenclamide, might be related to changes in serum chromium levels.     

Chromium picolinate increases membrane fluidity and rate of insulin internalization.

The effects of chromium chloride, chromium nicotinate, and chromium picolinate on insulin internalization in cultured rat skeletal muscle cells was examined. Insulin internalization was markedly increased in cells cultured in a medium that contained chromium picolinate and the increased internalization rate was accompanied by a marked increase in the uptake of both glucose and leucine. The effect was specific for chromium picolinate since neither zinc picolinate nor any of the other forms of chromium tested was effective. The increased insulin internalization rate may result from an increase in membrane fluidity since chromium picolinate and to a lesser extent, chromium nicotinate, increased the membrane fluidity of synthetic liposomal membranes.     

Zinc,selenium and chromium co-supplementation improves insulin resistance by preventing hepatic endoplasmic reticulum stress in diet-induced gestational diabetes rats

Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications and results in adverse outcomes for pregnant women and their offspring. Endoplasmic reticulum (ER) stress is associated with insulin resistance and implicates in the development of GDM. Zinc, selenium and chromium have been shown to maintain glucose homeostasis via multiple mechanisms, but how these trace elements affect the insulin resistance and ER stress in GDM are largely unknown. To address this, a GDM rat model was induced by feeding female Sprague-Dawley rats a high-fat (45%) and sucrose diet, while zinc (10 mg/kg.bw), selenium (20 ug/kg.bw), chromium (20 ug/kg.bw) were daily supplemented alone or in combination from 6 weeks before mating to the end of lactation period. Maternal metabolic parameters, hepatic ER stress and insulin signaling were analyzed. The results showed that zinc, selenium and chromium co-supplementation dramatically alleviated high-fat and sucrose-induced glucose intolerance and oxidative stress during entire experiment period. Hepatic ER stress as well as the unfolded protein response was activated in GDM dams, characterized by the up-regulation of glucose-regulated protein 78, phosphorylated the protein kinase RNA-like endoplasmic reticulum kinase, and the inositol-requiring enzyme 1α. Zinc, selenium and chromium supplementation significantly prevented this activation, by which contributes to the promotion of the phosphorylated protein kinase B related insulin signaling and maintenance of glucose homeostasis. In conclusion, zinc, selenium and chromium supplementation may be a promising way to prevent the development of GDM by alleviating hepatic ER stress.     

Chromium activates glucose transporter 4 trafficking and enhances insulin-stimulated glucose transport in 3T3-L1 adipocytes via a cholesterol-dependent mechanism

Evidence suggests that chromium supplementation may alleviate symptoms associated with diabetes, such as high blood glucose and lipid abnormalities, yet a molecular mechanism remains unclear. Here, we report that trivalent chromium in the chloride (CrCl3) or picolinate (CrPic) salt forms mobilize the glucose transporter, GLUT4, to the plasma membrane in 3T3-L1 adipocytes. Concomitant with an increase in GLUT4 at the plasma membrane, insulin-stimulated glucose transport was enhanced by chromium treatment. In contrast, the chromium-mobilized pool of transporters was not active in the absence of insulin. Microscopic analysis of an exofacially Myc-tagged enhanced green fluorescent protein-GLUT4 construct revealed that the chromium-induced accumulation of GLUT4-containing vesicles occurred adjacent to the inner cell surface membrane. With insulin these transporters physically incorporated into the plasma membrane. Regulation of GLUT4 translocation by chromium did not involve known insulin signaling proteins such as the insulin receptor, insulin receptor substrate-1, phosphatidylinositol 3-kinase, and Akt. Consistent with a reported effect of chromium on increasing membrane fluidity, we found that chromium treatment decreased plasma membrane cholesterol. Interestingly, cholesterol add-back to the plasma membrane prevented the beneficial effect of chromium on both GLUT4 mobilization and insulin-stimulated glucose transport. Furthermore, chromium action was absent in methyl-beta-cyclodextrin-pretreated cells already displaying reduced plasma membrane cholesterol and increased GLUT4 translocation. Together, these data reveal a novel mechanism by which chromium may enhance GLUT4 trafficking and insulin-stimulated glucose transport. Moreover, these findings at the level of the cell are consistent with in vivo observations of improved glucose tolerance and decreased circulating cholesterol levels after chromium supplementation.     

Chromium chloride inhibits oxidative stress and TNF-alpha secretion caused by exposure to high glucose in cultured U937 monocytes.

Chromium supplementation has been proposed to promote the action of insulin and the lowering of blood glucose levels in diabetic patients. However, the molecular mechanism by which chromium increases insulin sensitivity is not known. Using U937 monocytes as a cell culture model, this study demonstrates that chromium inhibits the secretion of TNF-alpha, a cytokine known to inhibit the sensitivity and action of insulin. U937 cells were cultured with high levels of glucose (mimicking diabetes) in the presence or absence of chromium chloride in the medium at 37 degrees C for 24 h. This study demonstrates that chromium supplementation prevents the increase in TNF-alpha levels and oxidative stress caused by the high levels of glucose in cultured U937 monocytic cells. Similarly, chromium supplementation prevented elevated TNF-alpha secretion and lipid peroxidation levels in H(2)O(2)-treated U937 cells. This study demonstrates for the first time that chromium supplementation inhibits TNF-alpha secretion in U937 monocytes cultured in high-glucose medium, which appears to be mediated by its antioxidative effect. This provides evidence for a novel molecular mechanism by which chromium supplementation may increase insulin sensitivity and glycemic control in diabetic patients.     

Effects of dietary chromium and zinc on egg production, egg quality, and some blood metabolites of laying hens reared under low ambient temperature

This experiment was conducted to evaluate the effects of chromium (chromium picolinate, CrPic) and zinc (ZnSO₄·H₂O) on egg production, egg quality, and serum insulin, corticosterone, glucose, cholesterol, and total protein concentrations of laying hens reared under a low ambient temperature (6.8°C). One hundred twenty laying hens (Hy-Line; 32 wk old) were divided into 4 groups, 30 hens per group. The laying hens were fed the control diet (T1) or the control diet supplemented with either 400 μg of Cr/kg of diet (T2), 30 mg of Zn/kg of diet (T3), or 400 μg of Cr plus 30 mg of Zn/kg of diet (T4). Although the dry matter intake (DMI) was similar (p>0.05) for all treatment groups, supplemental chromium and zinc either individually or together increased live-weight change, egg production, and improved feed efficiency (p<0.05). However, no significant differences were observed between T4 and T2 or T3. Compared to T1, supplemental chromium and zinc increased egg weight, eggshell weight, eggshell thickness, egg specific gravity, and Haugh unit (p<0.05) in T2, T3, and T4 groups, among which there was no significant difference. Serum insulin concentration increased (p<0.05) and corticosterone concentration decreased (p<0.05) with dietary chromium and zinc supplementation. Serum glucose and cholesterol concentrations decreased (p<0.05) and protein concentrations increased (p<0.001) with dietary chromium and zinc supplementation in all treatment groups. The results of this study indicated that either supplemental dietary chromium or zinc increased plasma insulin and decreased corticosterone concentrations and that had a positive effect on performance of laying hens under low ambient temperature.     

Cellular chromium enhances activation of insulin receptor kinase

Chromium has been recognized for decades as a nutritional factor that improves glucose tolerance by enhancing in vivo insulin action, but the molecular mechanism is unknown. Here we report pretreatment of CHO-IR cells with chromium enhances tyrosine phosphorylation of the insulin receptor. Different chromium(III) compounds were effective at enhancing insulin receptor phosphorylation in intact cells, but did not directly activate recombinant insulin receptor kinase. The level of insulin receptor phosphorylation in cells can be increased by inhibition of the opposing protein tyrosine phosphatase (PTP1B), a target for drug development. However, chromium did not inhibit recombinant human PTP1B using either p-nitrophenyl phosphate or the tyrosine-phosphorylated insulin receptor as the substrate. Chromium also did not alter reversible redox regulation of PTP1B. Purified plasma membranes exhibited insulin-dependent kinase activity in assays using substrate peptides mimicking sites of Tyr phosphorylation in the endogenous substrate IRS-1. Plasma membranes prepared from chromium-treated cells had higher specific activity of insulin-dependent kinase relative to controls. We conclude that cellular chromium potentiates insulin signaling by increasing insulin receptor kinase activity, separate from inhibition of PTPase. Our results suggest that nutritional and pharmacological therapies may complement one another to combat insulin resistance, a hallmark of type 2 diabetes.     

Chromium-induced glucose uptake, superoxide anion production, and phagocytosis in cultured pulmonary alveolar macrophages of weanling pigs

The dose-dependent effects of chromium chloride (CrCl₃) and chromium picolinate (CrPic) were evaluated for their glucose uptake, superoxide anion (O ₂ ⁻ ) production, activity of glucose-6-phosphate dehydrogenase, and phagocytosis of incubated pulmonary alveolar macrophages in medium containing no or 5 × 10⁻⁸ M insulin. Glucose uptake was found to increase in cells treated with 20 μg/L CrCl₃. Incubation with 20 μg/L of CrPic enhanced glucose uptake and O ₂ ⁻ production in an insulin-dependent manner. However, the inclusion of CrPic to 100 μg/L in the medium absent of insulin also increased O ₂ ⁻ production. The activity of glucose-6-phosphate dehydrogenase was not affected by either the addition of Cr or insulin. The phagocytosis of Escherichia coli by macrophages was enhanced significantly (p<0.05) in medium containing 10–100 μg/L CrCl₃ or 20–100 μg/L CrPic in the presence of insulin. These results suggest that the addition of 10–20 μg/L CrCl₃ enhances directly the cellular activity of macrophages, whereas the effect of CrPic requires the cooperative action of insulin in enhancing their glucose uptake and phagocytosis.     

A comparison of the insulin-sensitive transport of chromium in healthy and model diabetic rats

In response to insulin, chromium(III) is moved from the blood to the tissues where it is ultimately lost in the urine, apparently as the oligopeptide chromodulin; this transfer of chromium is mediated by the protein transferrin. To examine the effects of type 1 and type 2 diabetes on the transport of chromium, the fate of chromium from intravenously introduced (51)Cr(2)-labelled transferrin was monitored after 2 h in healthy and diabetic model rats; the effects of insulin on the transport of chromium in these groups were also examined. Diabetic rats had greater urinary chromium loss, greater movement of chromium from the blood to the tissues, most notably to the skeletal muscle, and an alteration of the distribution of chromium in the blood plasma.     

Insulin sensitising action of chromium picolinate in various experimental models of diabetes mellitus.

Although chromium is an essential element for carbohydrate and lipid metabolism, its effects in diabetic patients are still debated. We have studied the effect of 6 week treatment with chromium picolinate (8 microg/ml in drinking water) in streptozotocin (STZ)-induced type 1 and type 2 diabetic rat models. The mechanism of anti-diabetic action of chromium picolinate was studied using C2C12 myoblasts and 3T3-L1 adipocytes. Chromium picolinate significantly decreased the area under the curve over 120 min for glucose of both STZ-induced type 1 (40mg/kg, i.v. in adult rats) and type 2 (90 mg/kg, i.p. in 2 day old rat neonates) diabetic rats without any significant change in area under the curve over 120 min for insulin as compared to controls. The composite insulin sensitivity index and insulin sensitivity index (KITT) values of both type 1 and type 2 diabetic rats were increased significantly by chromium picolinate. Treatment with chromium picolinate produced a significant decrease in elevated cholesterol and triglyceride levels in both types of diabetic rats. In 3T3-L1 adipocytes, chromium picolinate (0-10 micromol) per se did not produce any effect, however, when co-incubated with insulin it significantly increased the intracellular triglyceride synthesis (EC50 = 363.7nmol/1). Similarly in C2C12 myoblasts, chromium picolinate alone did not produce any effect, however, it significantly increased insulin-induced transport of 14C-glucose. In conclusion, chromium picolinate significantly improves deranged carbohydrate and lipid metabolism of experimental chemically induced diabetes in rats. The mechanism of in vivo anti-diabetic action appears to be peripheral (skeletal muscle and adipose tissue) insulin enhancing action of chromium.     

铬与胰岛素敏感性

铬可以提高动物机体组织对胰岛素的敏感性,但对其具体作用机制直到最近才有了较深入的认识.铬在吸收后主要由转铁蛋白运输.血液胰岛素水平升高可以促进转铁蛋白受体从细胞内的小泡中移位到细胞膜上.携带铬的转铁蛋白与细胞膜表面的转铁蛋白受体发生结合,通过内吞作用将铬转运到细胞内.在细胞内,内吞小泡中的酸性环境可使铬从转铁蛋白中释放,4个三价铬离子与apochromodulin形成有活性的holochromodulin. Holochromodulin 除了可与胰岛素和/或胰岛素受体直接结合起作用外,还可以通过激活AMPK激酶来降低细胞膜胆固醇含量,改善细胞骨架功能,促进GLUT4移位,然后又通过激活p38MAPK激酶增强GLUT4的内在活性,从而促进葡萄糖吸收.但其具体分子机制仍不完全清楚.本文就铬在提高动物机体组织对胰岛素的敏感性的作用机制问题进行综述.