Ishizuka Toshiharu, Tokuyama Yoshiharu, Kanatsuka Azuma
Credo Sato Clinic, Japan.
Intern Med. 2013;52(24):2777-80. doi: 10.2169/internalmedicine.52.0932.
We herein report the case of a patient with slowly progressive type 1 diabetes and insulin independence lasting for >10 years despite the detection of continuously elevated glutamic acid decarboxylase autoantibody titers. We monitored the patient's clinical course and analyzed his endogenous insulin secretion and sensitivity using an intravenous glucose tolerance test (IVGTT) and oral glucose tolerance test (OGTT). His body mass index remained at approximately 22, while his serum C-peptide immunoreactivity level gradually decreased. The level of insulin secretion was significantly higher on the OGTT than the IVGTT. The patient's insulin sensitivity was within the normal limits. These results suggest that maintaining a lifestyle sufficient to preserve insulin secretion and/or normal insulin sensitivity is important and that β-cell responsiveness to incretins may, in part, contribute to insulin independence.
我们在此报告一例1型糖尿病患者的病例，该患者病情进展缓慢，尽管检测到谷氨酸脱羧酶自身抗体滴度持续升高，但胰岛素独立状态持续超过10年。我们监测了患者的临床病程，并使用静脉葡萄糖耐量试验（IVGTT）和口服葡萄糖耐量试验（OGTT）分析了他的内源性胰岛素分泌和敏感性。他的体重指数维持在约22，而血清C肽免疫反应性水平逐渐下降。OGTT时的胰岛素分泌水平显著高于IVGTT。患者的胰岛素敏感性在正常范围内。这些结果表明，维持足以保留胰岛素分泌和/或正常胰岛素敏感性的生活方式很重要，并且β细胞对肠促胰岛素的反应性可能部分促成了胰岛素独立状态。
