Viviani G L, Pacini G
Department of Internal Medicine (DIMI), University of Genova, Italy.
Aging (Milano). 1999 Jun;11(3):169-75.
One of the factors determining glucose tolerance is glucose disappearance independent from the dynamic insulin (glucose effectiveness); the debate on its role in the development of Type-2 diabetes is still open. The aim of the present study was to evaluate insulin delivery, insulin sensitivity (SI), and glucose effectiveness (SG) in a group of elderly Type-2 diabetic patients (D, 4/6 F/M, age 67 +/- 2 years, 64 +/- 2 kg, BMI 23.8 +/- 0.5 kg/m2), compared to young controls (C, 4/6 F/M, 25 +/- 2 years, 72 +/- 4 kg, 23.7 +/- 1.1 kg/m2) and elderly controls (E, 2/4 F/M, 73 +/- 3 years, 63 +/- 4 kg, 23.1 +/- 0.5 kg/m2). We performed oral (OGTT) and intravenous (FSIGT) glucose tolerance tests. The OGTT showed that C and E were normotolerant, while D had a markedly reduced glucose tolerance. This was also confirmed in the FSIGT where the glucose tolerance index (KG) was 0.6 +/- 0.1% min-1 in D vs 1.8 +/- 0.2 in C and 1.5 +/- 0.2 in E (p < 0.0002). Total insulin area of D and the overall insulin delivery were not different from those of the control groups. The early phase area was instead significantly reduced (0.19 +/- 0.02 mU min/mL vs 0.61 +/- 0.06 of C and 0.46 +/- 0.06 of E, p < 0.001) given the reduction in the dynamic first-phase insulin delivery (0.86 +/- 0.17 min(microU/mL)/(mg/dL) vs 3.95 +/- 0.61 in C (p < 0.005) and 2.61 +/- 0.66 (p < 0.001) in E). SI of D was 3.4 +/- 0.4 10(-4) min-1/(microU/mL), not different from that of C (4.7 +/- 0.6) and E (3.5 +/- 0.2). This study showed a marked difference between SG of D and that of both control groups [0.010 +/- 0.001 min-1 vs 0.026 +/- 0.004 (p < 0.001) of C and 0.020 +/- 0.003 (p < 0.002) of E], mostly due to the zero-insulin component GEZI which was 0.006 +/- 0.001 in D vs 0.021 +/- 0.004 in C and 0.016 +/- 0.003 in E (p < 0.003). In the elderly groups, when taken together, SG exhibited a positive correlation with the area under insulin concentration during the early phase and with KG (r = 0.69, p = 0.0032 and r = 0.90, p = 0.0001, respectively), demonstrating the importance of the first-phase insulin delivery in modulating glucose effectiveness and glucose tolerance.
决定糖耐量的因素之一是独立于动态胰岛素作用的葡萄糖清除率（葡萄糖效能）；关于其在2型糖尿病发生发展中作用的争论仍在继续。本研究的目的是评估一组老年2型糖尿病患者（D组，4名女性/6名男性，年龄67±2岁，体重64±2kg，体重指数23.8±0.5kg/m²）的胰岛素分泌、胰岛素敏感性（SI）和葡萄糖效能（SG），并与年轻对照组（C组，4名女性/6名男性，25±2岁，体重72±4kg，体重指数23.7±1.1kg/m²）和老年对照组（E组，2名女性/4名男性，73±3岁，体重63±4kg，体重指数23.1±0.5kg/m²）进行比较。我们进行了口服葡萄糖耐量试验（OGTT）和静脉葡萄糖耐量试验（FSIGT）。OGTT显示C组和E组糖耐量正常，而D组糖耐量显著降低。FSIGT也证实了这一点，D组的葡萄糖耐量指数（KG）为0.6±0.1%min⁻¹，而C组为1.8±0.2，E组为1.5±0.2（p<0.0002）。D组的总胰岛素分泌量和总体胰岛素分泌与对照组无差异。然而，由于动态第一相胰岛素分泌减少（D组为0.86±0.17min（μU/mL）/（mg/dL）），C组为3.95±0.61（p<0.005），E组为2.61±0.66（p<0.001），早期相面积显著降低（0.19±0.02mU min/mL，C组为0.61±0.06，E组为0.46±0.06，p<0.001）。D组的SI为3.4±0.4×10⁻⁴min⁻¹/（μU/mL），与C组（4.7±0.6）和E组（3.5±0.2）无差异。本研究显示D组的SG与两个对照组之间存在显著差异[D组为0.010±0.001min⁻¹，C组为0.026±0.004（p<0.001），E组为0.020±0.003（p<0.002）]，主要是由于零胰岛素成分GEZI，D组为0.006±0.001，C组为0.021±0.004，E组为0.016±0.003（p<0.003）。在老年组中，SG与早期相胰岛素浓度曲线下面积以及KG呈正相关（r分别为0.69，p = 0.0032和r = 0.90，p = 0.0001），这表明第一相胰岛素分泌在调节葡萄糖效能和糖耐量方面的重要性。
Zotero 插件