Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
Diabetes Obes Metab. 2018 Feb;20(2):370-377. doi: 10.1111/dom.13081. Epub 2017 Oct 2.
AIM: To test the hypothesis that dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, improves β-cell responses to incretin hormones (or β-cell incretin sensitivity) by alleviating glucose toxicity in people with type 2 diabetes mellitus (T2DM). METHODS: A total of 19 people with T2DM underwent a 3-hour hyperglycaemic clamp study with incretin infusion before and after 8-week treatment with dapagliflozin added to the background treatment. In addition, 10 people with normal glucose tolerance (NGT) underwent a single hyperglycaemic clamp study. The hyperglycaemic clamp was targeted at 15.5 mmol/L for 3 hours, with synthetic glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) infusion over a 60- to 180-minute and a 120- to 180-minute period, respectively. RESULTS: Compared with baseline, the C-peptide response to GLP-1 (incremental area under the curve [iAUC] of C-peptide ) significantly increased (83.6 ± 42.1 to 106.6 ± 45.7 nmol/L × min; P = .011), and the C-peptide response to GIP/GLP-1 (iAUC of C-peptide ) tended to increase after dapagliflozin treatment (82.5 ± 58.4 to 101.9 ± 50.3 nmol/L × min; P = .087), whereas both the insulin responses to GLP-1 and GIP/GLP-1 increased significantly. First-phase C-peptide response, which reflects β-cell function, significantly increased after dapagliflozin treatment; however, all these improved values in the participants with T2DM were far lower than those in the participants with NGT. In addition, the improvement in insulin responses to hyperglycaemia was correlated with the improvement in insulin responses to incretin infusion. CONCLUSIONS: Dapagliflozin improved β-cell responses to incretin hormones as well as glucose during the hyperglycaemic clamp in patients with inadequately controlled T2DM.
目的:检验钠-葡萄糖协同转运蛋白 2 抑制剂达格列净通过减轻 2 型糖尿病(T2DM)患者的葡萄糖毒性,改善肠促胰岛素激素(或β细胞肠促胰岛素敏感性)的假设。
方法:19 例 T2DM 患者在接受达格列净联合背景治疗 8 周前后分别进行了 3 小时高血糖钳夹试验和肠促胰岛素输注。此外,10 例糖耐量正常(NGT)者进行了单次高血糖钳夹试验。高血糖钳夹目标为 15.5mmol/L,持续 3 小时,分别在 60 至 180 分钟和 120 至 180 分钟期间输注合成胰高血糖素样肽-1(GLP-1)和葡萄糖依赖性胰岛素释放肽(GIP)。
结果:与基线相比,GLP-1 引起的 C 肽反应(C 肽增量 AUC)显著增加(83.6±42.1 至 106.6±45.7nmol/L×min;P=0.011),达格列净治疗后 GIP/GLP-1 引起的 C 肽反应(C 肽增量 AUC)呈增加趋势(82.5±58.4 至 101.9±50.3nmol/L×min;P=0.087),而 GLP-1 和 GIP/GLP-1 引起的胰岛素反应均显著增加。反映β细胞功能的第一时相 C 肽反应在达格列净治疗后显著增加;然而,T2DM 患者的所有这些改善值均远低于 NGT 患者。此外,高血糖时胰岛素反应的改善与肠促胰岛素输注时胰岛素反应的改善相关。
结论:达格列净改善了血糖控制不佳的 T2DM 患者高血糖钳夹期间对肠促胰岛素激素的β细胞反应以及血糖。
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