在 2 型糖尿病患者中，第一时相胰岛素分泌对餐后血糖的影响有限：高血糖钳夹与进餐试验之间的相关性。

First-phase insulin secretion has limited impact on postprandial glycemia in subjects with type 2 diabetes: correlations between hyperglycemic glucose clamp and meal test.

机构信息

Profil Institut für Stoffwechselforschung GmbH, 41460 Neuss, Germany.

出版信息

Diabetes Technol Ther. 2010 Feb;12(2):117-23. doi: 10.1089/dia.2009.0103.

DOI:10.1089/dia.2009.0103

PMID:20105041

Abstract

BACKGROUND

Lack of first-phase insulin (INS) secretion is regarded as causative for high postprandial glucose excursions in subjects with type 2 diabetes. We aimed to determine the impact of early INS secretion on postprandial glycemia.

METHODS

Twenty subjects with type 2 diabetes (age 54 +/- 8 years, body mass index 28.7 +/- 2.7 kg/m(2) [mean +/- SD]) underwent a hyperglycemic glucose clamp and a meal test twice separated by a washout period of 4 weeks. Multiple regression analysis was used to identify determinants of postprandial glycemia.

RESULTS

During hyperglycemic glucose clamps eight subjects showed a preserved first-phase INS secretion (P1+), whereas 12 subjects showed none (P1-). Both subject groups differed in fasting blood glucose (BG) (116 +/- 7 vs. 147 +/- 31 mg/dL, P = 0.011) and glycosylated hemoglobin (6.0 +/- 0.4 vs. 6.7 +/- 0.8, P = 0.041). Total INS secretory response during glucose clamps was higher in P1+ than P1- (INS-area under the concentration vs. time curve [AUC](0-120 min) 6.7 +/- 2.7 vs. 3.2 +/- 2.1 mU.min/mL; P = 0.006). During meal tests, however, INS-AUC(0-120 min) was similar between P1+ and P1-, whereas early INS secretion was still different (INS-AUC(0-60 min) 3.9 +/- 1.8 vs. 2.1 +/- 1.0 mU.min/mL; P = 0.031). Despite higher INS-AUC(0-60 min) in P1+, early postprandial BG was comparable between groups (BG-AUC(0-60 min) 1.5 +/- 0.5 vs. 1.6 +/- 0.6 g.min/dL; difference not significant). Multiple regression analyses showed no impact of first-phase INS secretion on postprandial glycemia, either in P1+ or in P1-. Nevertheless, in P1-, but not in P1+, postprandial glycemia was negatively correlated with INS sensitivity (R(2) = 0.83, P < 0.001).

CONCLUSIONS

This study, correlating results of hyperglycemic glucose clamps with meal tests, shows that a preserved first-phase INS secretion has only a limited impact on postprandial glucose excursions in a group of subjects in early-stage type 2 diabetes.

摘要

背景

在 2 型糖尿病患者中，缺乏第一时相胰岛素（INS）分泌被认为是导致餐后高血糖的原因。我们旨在确定早期 INS 分泌对餐后血糖的影响。

方法

20 例 2 型糖尿病患者（年龄 54 ± 8 岁，体重指数 28.7 ± 2.7 kg/m²[平均值 ± SD]）接受了高血糖葡萄糖钳夹和餐食测试两次，两次之间有 4 周的洗脱期。采用多元回归分析确定餐后血糖的决定因素。

结果

在高血糖葡萄糖钳夹期间，8 例患者表现出保留的第一时相 INS 分泌（P1+），而 12 例患者没有（P1-）。两组患者的空腹血糖（BG）（116 ± 7 与 147 ± 31 mg/dL，P = 0.011）和糖化血红蛋白（6.0 ± 0.4 与 6.7 ± 0.8，P = 0.041）不同。葡萄糖钳夹期间的总 INS 分泌反应在 P1+中高于 P1-（INS-浓度时间曲线下面积[AUC]（0-120 min）6.7 ± 2.7 与 3.2 ± 2.1 mU·min/mL；P = 0.006）。然而，在餐食测试中，P1+和 P1-之间的 INS-AUC（0-120 min）相似，而早期 INS 分泌仍然不同（INS-AUC（0-60 min）3.9 ± 1.8 与 2.1 ± 1.0 mU·min/mL；P = 0.031）。尽管 P1+中的 INS-AUC（0-60 min）较高，但两组之间的早期餐后 BG 相当（BG-AUC（0-60 min）1.5 ± 0.5 与 1.6 ± 0.6 g·min/dL；差异无统计学意义）。多元回归分析显示，第一时相 INS 分泌对餐后血糖无影响，无论是在 P1+还是 P1-中。然而，在 P1-中，但不在 P1+中，餐后血糖与 INS 敏感性呈负相关（R²=0.83，P < 0.001）。