Department of Endocrinology, Sir Run Run Shaw Hospital Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
J Endocrinol Invest. 2013 Jul-Aug;36(7):489-96. doi: 10.3275/8811. Epub 2013 Jan 14.
Recent studies highlight an important role of ghrelin in glucose homeostasis, while the association between ghrelin regulation and glucose fluctuation is unclear.
We compared the effects of two postprandial hypoglycemic agents on ghrelin response and determined the contribution of ghrelin response to glucose stability in Type 2 diabetic (T2DM) patients.
Forty newly- diagnosed T2DM patients were randomly allocated to receive nateglinide or acarbose for 4 weeks, with twenty body mass index (BMI)-matched normoglycemic subjects as controls. Mean glucose values and daily average glucose excursion were assessed using continuous glucose monitoring system. Serum ghrelin levels were determined by enzyme-linked immunosorbent assay.
T2DM patients had similar fasting ghrelin levels (p=0.546), while their postprandial ghrelin suppressions at 30 min and 120 min were reduced as compared to BMI-matched normoglycemic controls (p<0.01). Both nateglinide and acarbose increased post-prandial ghrelin suppression at 120 min and reduced ghrelin area under the curve (AUCGHRL) (p<0.05), while only nateglinide increased postprandial ghrelin suppression at 30 min (p<0.01), which was positively correlated with the increased early-phase insulin secretion by 4 weeks of nateglinide therapy (r=0.48, p=0.05). The decrease in AUCGHRL was positively correlated with the decrease in daily average glucose excursion and mean glucose values either by 4 weeks of nateglinide or acarbose therapy (p<0.05).
Both nateglinide and acarbose increase post-prandial ghrelin suppression. Improved ghrelin regulation is most likely to play a role in glucose stability in T2DM patients with nateglinide or acarbose therapy.
最近的研究强调了 ghrelin 在葡萄糖稳态中的重要作用，而 ghrelin 调节与葡萄糖波动之间的关系尚不清楚。
我们比较了两种餐后低血糖药物对 ghrelin 反应的影响，并确定了 ghrelin 反应对 2 型糖尿病（T2DM）患者血糖稳定性的贡献。
40 名新诊断的 T2DM 患者被随机分配接受那格列奈或阿卡波糖治疗 4 周，20 名体重指数（BMI）匹配的正常血糖受试者作为对照。使用连续血糖监测系统评估平均血糖值和每日平均血糖波动。通过酶联免疫吸附试验测定血清 ghrelin 水平。
T2DM 患者空腹 ghrelin 水平相似（p=0.546），但与 BMI 匹配的正常血糖对照组相比，他们的餐后 30 分钟和 120 分钟 ghrelin 抑制作用降低（p<0.01）。那格列奈和阿卡波糖均增加了餐后 120 分钟 ghrelin 抑制作用，降低了 ghrelin 曲线下面积（AUCGHRL）（p<0.05），而只有那格列奈增加了餐后 30 分钟 ghrelin 抑制作用（p<0.01），这与那格列奈治疗 4 周时早期相胰岛素分泌的增加呈正相关（r=0.48，p=0.05）。AUCGHRL 的降低与那格列奈或阿卡波糖治疗 4 周后每日平均血糖波动和平均血糖值的降低呈正相关（p<0.05）。
那格列奈和阿卡波糖均增加了餐后 ghrelin 抑制作用。在接受那格列奈或阿卡波糖治疗的 T2DM 患者中，ghrelin 调节的改善很可能在血糖稳定性中发挥作用。
