Yagasaki H, Kobayashi K, Saitou T, Nagamine K, Mitsui Y, Mochizuki M, Kobayashi K, Cho H, Ohyama K, Amemiya S, Nakazawa S
Department of Pediatrics, University of Yamanashi, Japan.
Exp Clin Endocrinol Diabetes. 2010 Mar;118(3):195-9. doi: 10.1055/s-0029-1239518. Epub 2009 Oct 15.
Insulin-like growth factor binding protein-1 (IGFBP-1) is known to regulate the bioavailability of insulin-like growth factor (IGF) and the levels of IGFBP-1 are increased in the morning in patients with type 1 diabetes mellitus. We investigated the nocturnal fluctuations of glucose, IGFBP-1, and free IGF-1 levels with three insulin regimens.
Forty-eight type 1 diabetes patients were divided into three groups according to their basal insulin therapy (continuous subcutaneous insulin infusion [CSII], insulin glargine, NPH insulin). Blood samples were obtained every 2 h between 2 300 h and 0700 h to measure plasma glucose, IGFBP-1 and free IGF-1 levels.
The dawn phenomenon was more frequent with NPH (62.1%) than with glargine (16.6%, p<0.05) and CSII (14.3%, p<0.05). In the NPH group, the serum IGFBP-1 levels were markedly increased from 21.0+/-3.6 ng/ml at 2 300 h to 200.3+/-21.8 ng/ml at 0700 h and free IGF-1 levels were inversely decreased; these changes were partially suppressed in the CSII and glargine groups.
The use of insulin regimens that provide sufficient insulin levels in the early morning can suppress the dawn phenomenon, leading to improved glycemic control. The increase in circulating IGFBP-1 in the morning, as a result of waning of insulin action, lowers free IGF-1 levels and may cause insulin resistance.
胰岛素样生长因子结合蛋白-1（IGFBP-1）可调节胰岛素样生长因子（IGF）的生物利用度，1型糖尿病患者早晨的IGFBP-1水平会升高。我们采用三种胰岛素治疗方案研究了血糖、IGFBP-1和游离IGF-1水平的夜间波动情况。
48例1型糖尿病患者根据基础胰岛素治疗方案（持续皮下胰岛素输注[CSII]、甘精胰岛素、中性鱼精蛋白锌胰岛素[NPH胰岛素]）分为三组。在03:00至07:00期间每2小时采集一次血样，以测定血浆葡萄糖、IGFBP-1和游离IGF-1水平。
NPH组黎明现象的发生率（62.1%）高于甘精胰岛素组（16.6%，p<0.05）和CSII组（14.3%，p<0.05）。在NPH组中，血清IGFBP-1水平从03:00时的21.0±3.6 ng/ml显著升高至07:00时的200.3±21.8 ng/ml，游离IGF-1水平则呈相反方向降低；这些变化在CSII组和甘精胰岛素组中得到部分抑制。
采用能在清晨提供足够胰岛素水平的胰岛素治疗方案可抑制黎明现象，从而改善血糖控制。由于胰岛素作用减弱，早晨循环IGFBP-1增加，降低了游离IGF-1水平，并可能导致胰岛素抵抗。
