Bremer Jan Phillip, Baron Maria, Peters Horst, Oltmanns Kerstin M, Kern Werner, Fehm Horst L, Born Jan, Schultes Bernd
Department of Internal Medicine I, University of Luebeck, D-23538 Luebeck, Germany.
Metabolism. 2006 Mar;55(3):331-8. doi: 10.1016/j.metabol.2005.09.006.
Sexual dimorphisms in hypoglycemic counterregulation are well documented in young healthy and type 1 diabetic subjects. Here, we questioned whether sex differences in counterregulation are present also in type 2 diabetic patients who are in a postmenopausal state. In an attempt to answer this question, we examined hormonal responses to a single-step hypoglycemic clamp (50 mg/dL) in 15 postmenopausal women and 15 age-matched men. Patients were also matched for body mass index, HbA(1c), diabetes duration, and diabetes therapy. In addition to hormonal counterregulation, perception of symptoms as well as aspects of neurocognitive function (short-term memory of words and reaction time on an auditory vigilance task) was assessed at baseline and during the hypoglycemic clamp. Hypoglycemia induced a profound rise in almost all counterregulatory hormones, that is, epinephrine, norepinephrine, corticotropin, cortisol, and growth hormone (all P < .007), except for glucagon, which slightly decreased (P = .014). However, none of the responses differed between sexes (all P > .256). In addition, perceived symptoms (P < .001) as well as reaction time on the vigilance task (P < .001) increased, and short-term memory performance tended to deteriorate (P = .091) during hypoglycemia. Again these changes did not differ between the sexes (all P > .370). In sum, data suggest that, in contrast to previous observations in young, healthy, and type 1 diabetic subjects, sex does not represent an important determinant of hormonal, subjective, and neurocognitive responses to hypoglycemia in postmenopausal type 2 diabetic patients. However, the women in our study were all postmenopausal and not receiving hormone replacement therapy. Therefore, our results cannot be generalized to female patients with type 2 diabetes who are premenopausal or on hormone replacement therapy, that is, conditions characterized by increased blood estrogen levels.
低血糖反调节中的性别差异在年轻健康受试者和1型糖尿病患者中已有充分记录。在此，我们探讨绝经后2型糖尿病患者是否也存在反调节方面的性别差异。为回答这个问题，我们检测了15名绝经后女性和15名年龄匹配男性对单步低血糖钳夹（50 mg/dL）的激素反应。患者还在体重指数、糖化血红蛋白（HbA1c）、糖尿病病程和糖尿病治疗方面进行了匹配。除了激素反调节外，在基线和低血糖钳夹期间评估了症状感知以及神经认知功能方面（单词的短期记忆和听觉警觉任务中的反应时间）。低血糖导致几乎所有反调节激素显著升高，即肾上腺素、去甲肾上腺素、促肾上腺皮质激素、皮质醇和生长激素（均P < 0.007），但胰高血糖素略有下降（P = 0.014）。然而，两性之间的反应均无差异（均P > 0.256）。此外，在低血糖期间，症状感知（P < 0.001）以及警觉任务中的反应时间（P < 0.001）增加，短期记忆表现有恶化趋势（P = 0.091）。同样，这些变化在两性之间也无差异（均P > 0.370）。总之，数据表明，与年轻健康受试者和1型糖尿病患者的先前观察结果相反，性别并非绝经后2型糖尿病患者对低血糖的激素、主观和神经认知反应的重要决定因素。然而，我们研究中的女性均已绝经且未接受激素替代治疗。因此，我们的结果不能推广到绝经前或接受激素替代治疗的2型糖尿病女性患者，即具有血液雌激素水平升高特征的情况。
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