Leslie P, Jung R T, Isles T E, Baty J, Newton R W, Illingworth P
Br Med J (Clin Res Ed). 1986 Nov 1;293(6555):1121-6. doi: 10.1136/bmj.293.6555.1121.
To assess the role of insulin in the control of body weight energy expenditure was measured by indirect calorimetry in eight patients of normal weight with type I diabetes initially while poorly controlled during conventional insulin treatment and later during optimal glycaemic control achieved by using the continuous subcutaneous insulin infusion pump. Their response to seven days of fat supplementation was also assessed and the results compared with those in eight non-diabetic subjects. After a mean of 5.3 months of continuous subcutaneous insulin infusion the diabetic subjects had gained on average 3.5 kg. In the poorly controlled diabetic state the resting metabolic rate was raised but decreased by a mean of 374 kJ (90 kcal) per 24 hours with optimal glycaemic control. The thermic response to infused noradrenaline was reduced by 59% in the diabetic subjects, was not improved by continuous subcutaneous insulin infusion, but was improved when three of the subjects were given metformin in addition. The diabetic subjects had no abnormality in the thermic response to a meal while taking their usual diabetic diet. During fat supplementation, however, this thermic response was reduced when glycaemic control was poor but not when control was precise. Fat supplementation did not alter the resting metabolic rate or the reduced noradrenergic thermic response in the diabetic subjects. These findings suggest that precise glycaemic control could produce weight gain if energy intake remained unaltered, for diabetic subjects do not compensate for the decrease in metabolic rate by an increase in noradrenergic and dietary thermic responses. Also precise glycaemic control using continuous subcutaneous insulin infusion does not correct all the metabolic abnormalities of diabetes mellitus.
为评估胰岛素在体重控制中的作用，对8例体重正常的Ⅰ型糖尿病患者进行了间接测热法测量能量消耗。最初在常规胰岛素治疗期间血糖控制不佳，之后通过持续皮下胰岛素输注泵实现最佳血糖控制。还评估了他们对7天脂肪补充的反应，并将结果与8名非糖尿病受试者的结果进行比较。在平均5.3个月的持续皮下胰岛素输注后，糖尿病受试者平均体重增加了3.5千克。在血糖控制不佳的糖尿病状态下，静息代谢率升高，但在最佳血糖控制下，每24小时平均降低374千焦（90千卡）。糖尿病受试者对输注去甲肾上腺素的热反应降低了59%，持续皮下胰岛素输注并未改善，但当其中3名受试者同时服用二甲双胍时有所改善。糖尿病受试者在食用常规糖尿病饮食时对进餐的热反应无异常。然而，在脂肪补充期间，当血糖控制不佳时这种热反应降低，但控制精确时则不然。脂肪补充并未改变糖尿病受试者的静息代谢率或降低的去甲肾上腺素能热反应。这些发现表明，如果能量摄入不变，精确的血糖控制可能会导致体重增加，因为糖尿病受试者不会通过增加去甲肾上腺素能和饮食热反应来补偿代谢率的降低。此外，使用持续皮下胰岛素输注进行精确的血糖控制并不能纠正糖尿病的所有代谢异常。
