Steffin B, Gutt B, Bidlingmaier M, Dieterle C, Oltmann F, Schopohl J
Medizinische Klinik Innenstadt, Department of Endocrinology, University of Munich, Munich, Germany.
Eur J Endocrinol. 2006 Jul;155(1):73-8. doi: 10.1530/eje.1.02185.
Treatment with somatostatin analogues (SA) not only inhibits GH secretion but may also impair insulin secretion. In order to evaluate the influence of SA on glucose metabolism, we investigated insulin resistance (IR) and beta-cell function, using the recommended combination of homeostatic model assessment of IR (HOMA-IR) and beta-cell function (HOMA-beta).
This is a prospective, cross-sectional study. We measured fasting insulin, blood glucose and IGF-I. Insulin and blood glucose measurements were taken 120 min after an oral glucose tolerance test with 75 g glucose. We studied 51 patients (27 female/24 male, age 54 years (20-75)). Eighteen patients were on Lanreotide Autogel (LA) treatment, 33 had no medical treatment. GH-levels of more than 2.5 ng/ml was reached by 59% of the patients, 74.5% had normal IGF-I levels.
We found no significant influence of disease activity on HOMA-IR and HOMA-beta. In the 33 of 51 subjects without any drug treatment, median HOMA-beta was 170.4% (36.0-624.0%). In contrast, in the 18 patients on LA treatment, median HOMA-beta was found to be significantly lower (84.2% (36.5-346.2%); P = 0.001). Despite this, there was no difference in HOMA-IR in both groups (2.4 (0.7-8.4) vs 2.3 (0.7-6.1); P < 0.001) despite similar insulin values.
In conclusion, we found that LA decreases beta-cell function significantly without affecting IR. Therefore, we think that insulin secretagogues are probably more effective in the treatment of diabetes mellitus in acromegalic patients on LA therapy than insulin sensitizers.
生长抑素类似物（SA）治疗不仅抑制生长激素（GH）分泌，还可能损害胰岛素分泌。为评估SA对糖代谢的影响，我们采用推荐的胰岛素抵抗（IR）稳态模型评估和β细胞功能（HOMA-β）联合方法，对IR和β细胞功能进行了研究。
这是一项前瞻性横断面研究。我们测量了空腹胰岛素、血糖和胰岛素样生长因子-I（IGF-I）。在口服75g葡萄糖耐量试验120分钟后测量胰岛素和血糖。我们研究了51例患者（27例女性/24例男性，年龄54岁（20 - 75岁））。18例患者接受兰瑞肽长效注射剂（LA）治疗，33例未接受药物治疗。59%的患者GH水平超过2.5ng/ml，74.5%的患者IGF-I水平正常。
我们发现疾病活动度对HOMA-IR和HOMA-β无显著影响。在51例未接受任何药物治疗的受试者中，HOMA-β中位数为170.4%（36.0 - 624.0%）。相比之下，在接受LA治疗的18例患者中，HOMA-β中位数显著更低（84.2%（36.5 - 346.2%）；P = 0.001）。尽管如此，两组的HOMA-IR无差异（2.4（0.7 - 8.4）对2.3（0.7 - 6.1）；P < 0.001），尽管胰岛素值相似。
总之，我们发现LA显著降低β细胞功能而不影响IR。因此，我们认为在接受LA治疗的肢端肥大症患者中，胰岛素促分泌剂可能比胰岛素增敏剂在糖尿病治疗中更有效。
