Staehr P, Hojlund K, Hother-Nielsen O, Holst J J, Beck-Nielsen H
Diabetes Research Centre, Department of Endocrinology M, Odense University Hospital, Kloevervaenget 4 (3rd floor), DK-5000 Odense C, Denmark.
Diabet Med. 2003 Oct;20(10):816-22. doi: 10.1046/j.1464-5491.2003.01004.x.
In order to perform euglycaemic clamp studies in Type 2 diabetic patients, plasma glucose must be reduced to normal levels. This can be done either (i) acutely during the clamp study using high-dose insulin infusion, or (ii) slowly overnight preceding the clamp study using a low-dose insulin infusion. We assessed whether the choice of either of these methods to obtain euglycaemia biases subsequent assessment of glucose metabolism and insulin action.
We studied seven obese Type 2 diabetic patients twice: once with (+ ON) and once without (- ON) prior overnight insulin infusion. Glucose turnover rates were quantified by adjusted primed-constant 3-3H-glucose infusions, and insulin action was assessed in 4-h euglycaemic, hyperinsulinaemic (40 mU m-2 min-1) clamp studies using labelled glucose infusates (Hot-GINF).
Basal plasma glucose levels (mean +/- sd) were 5.5 +/- 0.5 and 10.7 +/- 2.9 mmol/l in the + ON and - ON studies, respectively, and were clamped at -5.5 mmol/l. Basal rates of glucose production (GP) were similar in the + ON and - ON studies, 83 +/- 13 vs. 85 +/- 14 mg m-2 min-1 (NS), whereas basal rates of glucose disappearance (Rd) were lower in the + ON than in the - ON study, 84 +/- 8 vs. 91 +/- 11 mg m-2 min-1 (P = 0.02). During insulin infusion in the clamp period, rates of GP, 23 +/- 11 vs. 25 +/- 10 mg m-2 min-1, as well as rates of Rd, 133 +/- 32 vs. 139 +/- 37 mg m-2 min-1, were similar in the + ON and - ON studies, respectively (NS).
Apart from basal rates of Rd, assessment of glucose turnover rates in euglycaemic clamp studies of Type 2 diabetic patients is not dependent on the method by which plasma glucose levels are lowered.
为了对2型糖尿病患者进行正常血糖钳夹研究，必须将血浆葡萄糖水平降至正常。这可以通过以下两种方法之一来实现：（i）在钳夹研究期间使用高剂量胰岛素输注急性降低血糖，或（ii）在钳夹研究前一晚使用低剂量胰岛素输注缓慢降低血糖。我们评估了选择这两种方法中的任何一种来实现正常血糖水平是否会影响随后对葡萄糖代谢和胰岛素作用的评估。
我们对7名肥胖的2型糖尿病患者进行了两次研究：一次在夜间预先输注胰岛素后进行（+ON），一次未进行夜间预先输注胰岛素（-ON）。通过调整后的单次静脉注射-持续静脉输注3-3H-葡萄糖来定量葡萄糖周转率，并在4小时正常血糖、高胰岛素血症（40 mU m-2 min-1）钳夹研究中使用标记的葡萄糖输注液（Hot-GINF）评估胰岛素作用。
在+ON和-ON研究中，基础血浆葡萄糖水平（平均值±标准差）分别为5.5±0.5和10.7±2.9 mmol/l，并被钳夹在-5.5 mmol/l。在+ON和-ON研究中，基础葡萄糖生成率（GP）相似，分别为83±13与85±14 mg m-2 min-1（无显著性差异），而基础葡萄糖消失率（Rd）在+ON研究中低于-ON研究，分别为84±8与91±11 mg m-2 min-1（P = 0.02）。在钳夹期胰岛素输注期间，+ON和-ON研究中的GP率分别为23±11与25±10 mg m-2 min-1，以及Rd率分别为133±32与139±37 mg m-2 min-1，均相似（无显著性差异）。
除基础Rd率外，2型糖尿病患者正常血糖钳夹研究中葡萄糖周转率的评估不依赖于降低血浆葡萄糖水平的方法。
