Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, St. Vincent’s Hospital, Suwon, Korea.
Am J Physiol Endocrinol Metab. 2011 Nov;301(5):E984-90. doi: 10.1152/ajpendo.00244.2011. Epub 2011 Aug 9.
Improved glucose tolerance following a sequential meal is known as the second-meal phenomenon. We aimed to investigate its extent and underlying mechanisms in patients with type 2 diabetes. Metabolic responses after lunch in 12 diabetic patients were compared on two separate days: one with (Day BL) and another without (Day FL) breakfast. The responses of hormones were calculated by the incremental area under the curve (iAUC) values for 180 min after each meal. Indexes of early-phase insulin secretion were assessed, and β-cell function was estimated by mathematical modeling. [iAUC(glucose(180-360 min))] was significantly lower on Day BL than on Day FL (181 ± 43 vs. 472 ± 29 mmol·liter(-1)·min, P = 0.0005). The magnitude of the The second-meal phenomenon [iAUC(glucose(180-360 min)) on Day BL/Day FL] was 35 ± 9%. The peak levels of insulin and C-peptide were attained 45 min earlier after the second meal than after the first meal. iAUC(glucose(180-360 min)) correlated negatively with iAUC(insulin(180-210 min)) (r = -0.443, P = 0.0300), insulinogenic index (r = -0.769, P < 0.0001), acute C-peptide response (r = -0.596, P = 0.0021), and potentiation factor [i.e., potentiation effect on insulin secretion] ratio (180-360)/(0-20) (r = -0.559, P = 0.0045), while correlated positively with free fatty acid level before lunch (r = 0.679, P = 0.0003). The second-meal phenomenon was evident in patients with type 2 diabetes. Potentiation of the early-phase insulin response by a prior meal contributes to this phenomenon in type 2 diabetes.
进餐后血糖耐受性改善被称为第二餐现象。我们旨在研究其在 2 型糖尿病患者中的程度和潜在机制。在两天内分别比较了 12 名糖尿病患者午餐后的代谢反应：一天有（BL 日）和另一天没有（FL 日）早餐。通过每餐 180 分钟后的增量曲线下面积（iAUC）值计算激素反应。评估早期胰岛素分泌指数，并通过数学建模估计β细胞功能。BL 日的[iAUC（葡萄糖（180-360 分钟））]明显低于 FL 日（181 ± 43 对 472 ± 29 mmol·liter(-1)·min，P = 0.0005）。第二餐现象的幅度 [iAUC（葡萄糖（180-360 分钟））在 BL 日/FL 日]为 35 ± 9%。第二餐比第一餐后 45 分钟达到胰岛素和 C 肽的峰值水平。iAUC（葡萄糖（180-360 分钟））与 iAUC（胰岛素（180-210 分钟））呈负相关（r = -0.443，P = 0.0300），胰岛素原指数（r = -0.769，P < 0.0001），急性 C 肽反应（r = -0.596，P = 0.0021）和增效因子[即胰岛素分泌的增效作用]比（180-360）/（0-20）（r = -0.559，P = 0.0045），而与午餐前游离脂肪酸水平呈正相关（r = 0.679，P = 0.0003）。第二餐现象在 2 型糖尿病患者中很明显。进餐后早期胰岛素反应的增强促成了 2 型糖尿病中的这种现象。
