Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands.
Diabetologia. 2012 Apr;55(4):1186-94. doi: 10.1007/s00125-011-2435-7. Epub 2012 Jan 10.
AIMS/HYPOTHESIS: The aim of this study was to compare IGF-I bioactivity 36 weeks after the addition of insulin glargine (A21Gly,B31Arg,B32Arg human insulin) or NPH insulin to metformin therapy in type 2 diabetic patients who had poor glucose control under metformin monotherapy.
In the Lantus plus Metformin (LANMET) study, 110 poorly controlled insulin-naive type 2 diabetic patients were randomised to receive metformin with either insulin glargine (G+MET) or NPH insulin (NPH+MET). In the present study, IGF-I bioactivity was measured, retrospectively, in 104 out of the 110 initially included LANMET participants before and after 36 weeks of insulin therapy. IGF-I bioactivity was measured using an IGF-I kinase receptor activation assay.
After 36 weeks of insulin therapy, insulin doses were comparable between the G+MET (68 ± 5.7 U/day) and NPH+MET (71 ± 6.2 U/day) groups (p = 0.68). Before insulin therapy, circulating IGF-I bioactivity was similar between the G+MET (134 ± 9 pmol/l) and NPH+MET (135 ± 10 pmol/l) groups (p = 0.83). After 36 weeks, IGF-I bioactivity had decreased significantly (p = 0.001) and did not differ between the G+MET (116 ± 9 pmol/l) and NPH+MET (117 ± 10 pmol/l) groups (p = 0.91). At baseline and after insulin therapy, total IGF-I concentrations were comparable in both groups (baseline: G+MET 13.3 ± 1.0 vs NPH+MET 13.3 ± 1.0 nmol/l, p = 0.97; and 36 weeks: 13.4 ± 1.0 vs 13.1 ± 0.9 nmol/l, p = 0.71). Total IGF-I concentration did not change during insulin therapy (13.3 ± 0.7 vs 13.3 ± 0.7 nmol/l, baseline vs 36 weeks, p = 0.86).
CONCLUSIONS/INTERPRETATION: Addition of insulin glargine or NPH insulin to metformin monotherapy in poorly controlled type 2 diabetic patients decreases serum IGF-I bioactivity in a similar manner.
目的/假设：本研究的目的是比较甘精胰岛素（A21Gly、B31Arg、B32Arg 人胰岛素）或 NPH 胰岛素添加到二甲双胍治疗后 36 周时，血糖控制不佳的 2 型糖尿病患者的 IGF-I 生物活性。
在 Lantus plus Metformin（LANMET）研究中，110 名血糖控制不佳的胰岛素初治 2 型糖尿病患者被随机分为接受二甲双胍加甘精胰岛素（G+MET）或 NPH 胰岛素（NPH+MET）治疗。在本研究中，对最初纳入的 110 名 LANMET 参与者中的 104 名进行了回顾性 IGF-I 生物活性测量，这些参与者在胰岛素治疗前和 36 周后接受了测量。IGF-I 生物活性使用 IGF-I 激酶受体激活测定法进行测量。
在胰岛素治疗 36 周后，G+MET（68±5.7 U/天）和 NPH+MET（71±6.2 U/天）组之间的胰岛素剂量相当（p=0.68）。在胰岛素治疗前，G+MET（134±9 pmol/l）和 NPH+MET（135±10 pmol/l）组之间的循环 IGF-I 生物活性相似（p=0.83）。36 周后，IGF-I 生物活性显著降低（p=0.001），G+MET（116±9 pmol/l）和 NPH+MET（117±10 pmol/l）组之间无差异（p=0.91）。在基线和胰岛素治疗后，两组的总 IGF-I 浓度相当（基线：G+MET 13.3±1.0 与 NPH+MET 13.3±1.0 nmol/l，p=0.97；36 周：13.4±1.0 与 13.1±0.9 nmol/l，p=0.71）。胰岛素治疗期间总 IGF-I 浓度没有变化（13.3±0.7 与 13.3±0.7 nmol/l，基线与 36 周，p=0.86）。
结论/解释：在血糖控制不佳的 2 型糖尿病患者中，将甘精胰岛素或 NPH 胰岛素添加到二甲双胍单药治疗中，以相似的方式降低血清 IGF-I 生物活性。
