Saxena T, Maheshwari S, Goyal R K
Department of Medicine, JLN Medical College and AG Hospitals, Ajmer.
J Assoc Physicians India. 2000 Aug;48(8):815-7.
The study was performed to see that, whether metabolic control and response to treatment in freshly diagnosed patients of type 2 diabetes mellitus is affected by primary pathology (hyperinsulinemia/inappropriate insulin secretion).
One hundred and eight freshly diagnosed patients of type 2 diabetes mellitus with age range from 30-65 years were followed for a period of three months. The blood glucose, serum triglyceride, and serum insulin levels were determined in each patient. Patients were found to have either higher or normal to low serum insulin values at fasting, and accordingly patients were distributed into two groups; group one (normal to low initial fasting serum insulin level i.e. < or = 30 microU/ml) and group two (high fasting serum insulin level i.e. > or = 30 microU/ml). Each group was further divided into two subgroups A and B. Subgroup A was treated with glipizide and B with metformin.
Diabetic patients who had fasting hyperinsulinemia (n = 53, 100%) had blood pressure > or = 140/90 at the time of presentation. Patients who had fasting serum insulin within normal range only 30% (n = 17) had hypertension. Patients of group one had good recovery from hyperglycemia and reduction in triglyceride values when treated with sulphonylurea (subgroup A) as compared to patients treated with biguanide (subgroup B). On the contrary patients of group two showed poor glycemic control, increase in blood pressure and rise in serum triglyceride titre when treated with sulphonylurea (subgroup A) while in the same group biguanide effectively produced euglycemia with normalization of blood pressure and decrease in triglyceride levels (subgroup B).
Assessment of initial serum insulin levels is helpful guide to decide about the type of oral hypoglycemic agent to be used in freshly diagnosed patients to type 2 diabetes mellitus.
开展本研究以观察2型糖尿病新诊断患者的代谢控制及对治疗的反应是否受原发性病理改变（高胰岛素血症/胰岛素分泌异常）影响。
对108例年龄在30至65岁之间的2型糖尿病新诊断患者进行了为期三个月的随访。测定了每位患者的血糖、血清甘油三酯和血清胰岛素水平。发现患者空腹时血清胰岛素值要么较高，要么正常至较低，据此将患者分为两组；第一组（初始空腹血清胰岛素水平正常至较低，即≤30微单位/毫升）和第二组（空腹血清胰岛素水平较高，即≥30微单位/毫升）。每组再进一步分为两个亚组A和B。亚组A用格列吡嗪治疗，B用二甲双胍治疗。
空腹高胰岛素血症的糖尿病患者（n = 53，100%）就诊时血压≥140/90。空腹血清胰岛素在正常范围内的患者中只有30%（n = 17）患有高血压。与用双胍类药物治疗的患者（亚组B）相比，第一组患者用磺酰脲类药物（亚组A）治疗时高血糖恢复良好且甘油三酯值降低。相反，第二组患者用磺酰脲类药物（亚组A）治疗时血糖控制不佳、血压升高且血清甘油三酯水平上升，而在同一组中双胍类药物有效地使血糖正常化、血压恢复正常并降低了甘油三酯水平（亚组B）。
评估初始血清胰岛素水平有助于指导决定2型糖尿病新诊断患者应使用的口服降糖药类型。
