Yamamoto Toshiyuki, Oya Yasushi, Isobe Tateo, Shirafuji Toshihiko, Ogata Katsuhisa, Ogawa Masafumi, Kawai Mitsuru
Department of Neurology, National Center Hospital for Mental, Nervous and Muscular Disorders.
Rinsho Shinkeigaku. 2005 Apr;45(4):287-92.
We report beneficial effects of pioglitazone on insulin resistance in diabetes mellitus accompanied with myotonic dystrophy (DM1). We studied eight DM1 patients with diabetes mellitus aged 32 to 60 (mean age 52.1 +/- 8.6 years). Three of them were under glibenclamide treatment, but their plasma glucose control was poor because of occasional hypoglycemia; others had not been treated with any hypoglycemic drugs. We administered a daily dose of 15 mg pioglitazone for 6-36 months (mean period 14.8 +/- 9.1 months). Plasma glucose control improved in all patients. In a 75 g oral glucose tolerance test, plasma glucose level at 120 min dropped from 203.3 +/- 41.7 mg/dl to 153.9 +/- 39.5 mg/dl (p = 0.04); the area under the insulin curve up to 120 min (sigma IRI) dropped from 236.9 +/- 170.2 microU x hr/ml to 169.6 +/- 81.3 microU x hr/ml (p = 0.12). Sigma IRI decreased in four patients with pretreatment sigma IRI > or = 250 microU x hr/ml; it slightly increased in other patients with pretreatment sigma IRI < or = 150 microU x hr/ml. The homeostasis model assessment-insulin resistance (HOMA-IR) improved from 2.1 +/- 1.0 to 1.1 +/- 0.4 (p = 0.04). Impairment of liver functions, cardiac failure, or hypoglycemia was not observed. Pioglitazone treatment is useful to improve insulin resistance and glucose control in DM1 patients with diabetes mellitus, especially patients with reactive hyperinsulinemia to glucose loading.
我们报告了吡格列酮对伴有强直性肌营养不良（DM1）的糖尿病患者胰岛素抵抗的有益作用。我们研究了8例年龄在32至60岁（平均年龄52.1±8.6岁）的DM1糖尿病患者。其中3例正在接受格列本脲治疗，但由于偶尔发生低血糖，他们的血糖控制不佳；其他患者未接受任何降糖药物治疗。我们给予每日15mg吡格列酮，持续6至36个月（平均疗程14.8±9.1个月）。所有患者的血糖控制均得到改善。在75g口服葡萄糖耐量试验中，120分钟时的血糖水平从203.3±41.7mg/dl降至153.9±39.5mg/dl（p = 0.04）；至120分钟时胰岛素曲线下面积（σIRI）从236.9±170.2μU·hr/ml降至169.6±81.3μU·hr/ml（p = 0.12）。4例治疗前σIRI≥250μU·hr/ml的患者，其σIRI降低；其他治疗前σIRI≤150μU·hr/ml的患者，其σIRI略有升高。稳态模型评估胰岛素抵抗（HOMA-IR）从2.1±1.0改善至1.1±0.4（p = 0.04）。未观察到肝功能损害、心力衰竭或低血糖。吡格列酮治疗有助于改善DM1糖尿病患者的胰岛素抵抗和血糖控制，尤其是对葡萄糖负荷有反应性高胰岛素血症的患者。
