Department of Endocrinology, Metabolism and Diabetes, Faculty of Medicine, Kindai University, Osaka, Japan.
Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan.
J Diabetes Investig. 2018 Sep;9(5):1084-1090. doi: 10.1111/jdi.12799. Epub 2018 Jan 29.
AIMS/INTRODUCTION: Patients with a total pancreatectomy and type 1 diabetes are similar in regard to absolute insulin deficiency, but different in regard to glucagon, providing a unique opportunity to study the contribution of glucagon to glucose metabolism in an insulin-dependent state. The aim of the present study was to investigate the contribution of glucagon to glucose homeostasis in complete insulin deficiency in vivo.
A total of 38 individuals with a complete lack of endogenous insulin (fasting C-peptide <0.0066 nmol/L) and whose glycemic control was optimized with an insulin pump during hospitalization were retrospectively studied. The basal insulin requirement, time-to-time adjustment of the basal insulin infusion rate, prandial insulin requirement and fasting plasma glucagon were compared between patients with a total pancreatectomy (n = 10) and those with type 1 diabetes (n = 28) after achievement of optimal glycemic control.
Total daily insulin (P = 0.03) and basal insulin (P = 0.000006), but not prandial insulin requirements, were significantly lower in total pancreatectomy patients than in type 1 diabetes patients. The basal percentage (basal insulin/total daily insulin) was also significantly lower in total pancreatectomy patients than in type 1 diabetes patients (15.8 ± 7.8 vs 32.9 ± 10.1%, P = 0.00003). An increase in the insulin infusion rate early in the morning was not necessary in most patients with a pancreatectomy. The fasting plasma glucagon concentration was significantly lower in total pancreatectomy patients than in type 1 diabetes patients (P = 0.00007), and was positively correlated with the basal insulin requirement (P = 0.038).
The difference in insulin requirements between total pancreatectomy and type 1 diabetes patients suggests a contribution of glucagon to the basal insulin requirement and dawn phenomenon.
目的/引言：全胰切除术后合并 1 型糖尿病的患者在绝对胰岛素缺乏方面相似，但在胰高血糖素方面存在差异，这为研究在胰岛素依赖状态下胰高血糖素对葡萄糖代谢的贡献提供了独特的机会。本研究旨在研究在体内完全缺乏内源性胰岛素的情况下，胰高血糖素对葡萄糖稳态的贡献。
回顾性研究了 38 名完全缺乏内源性胰岛素（空腹 C 肽<0.0066 nmol/L）的个体，这些患者在住院期间通过胰岛素泵优化血糖控制。在达到最佳血糖控制后，比较了全胰切除术后患者（n=10）和 1 型糖尿病患者（n=28）的基础胰岛素需要量、基础胰岛素输注率的调整时间、餐前胰岛素需要量和空腹血浆胰高血糖素。
全胰切除术后患者的总日胰岛素（P=0.03）和基础胰岛素（P=0.000006）需求明显低于 1 型糖尿病患者，但餐前胰岛素需求则无差异。全胰切除术后患者的基础胰岛素比例（基础胰岛素/总日胰岛素）也明显低于 1 型糖尿病患者（15.8±7.8%比 32.9±10.1%，P=0.00003）。大多数全胰切除术后患者不需要在清晨早期增加胰岛素输注率。全胰切除术后患者的空腹血浆胰高血糖素浓度明显低于 1 型糖尿病患者（P=0.00007），且与基础胰岛素需求呈正相关（P=0.038）。
全胰切除术后患者和 1 型糖尿病患者胰岛素需求的差异表明胰高血糖素对基础胰岛素需求和黎明现象有贡献。
