Fraze E, Donner C C, Swislocki A L, Chiou Y A, Chen Y D, Reaven G M
J Clin Endocrinol Metab. 1985 Nov;61(5):807-11. doi: 10.1210/jcem-61-5-807.
Plasma glucose, insulin, and FFA concentrations were determined in 15 normal subjects and 15 patients with noninsulin-dependent diabetes mellitus (NIDDM) from 0800 to 1600 h. Breakfast and lunch were consumed at 0800 and 1200 h, respectively, and plasma concentrations were measured at hourly intervals from 0800-1600 h. Plasma glucose concentrations between 0800 and 1600 h were significantly elevated in patients with NIDDM, and the higher the fasting glucose level, the greater the postprandial hyperglycemia. Hyperglycemia in patients with NIDDM was associated with plasma insulin levels that were significantly higher (P less than 0.001) than those in normal subjects, and substantial hyperinsulinemia occurred between 0800 and 1600 h in patients with mild NIDDM (fasting plasma glucose concentrations, less than 140 mg/dl). Both fasting and postprandial FFA levels were also increased in patients with NIDDM (P less than 0.001), and the greater the plasma glucose response, the higher the FFA response (r = 0.70; P less than 0.001). However, there was no significant correlation between plasma insulin and FFA concentrations. More specifically, hyperinsulinemic patients with mild diabetes (fasting plasma glucose, less than 140 mg/dl) maintained normal ambient FFA levels, while FFA concentrations were significantly elevated in patients with severe NIDDM (fasting plasma glucose, greater than 250 mg/dl), with insulin concentrations comparable to those in normal subjects. These results demonstrate that patients with NIDDM are not capable of maintaining normal plasma FFA concentrations. This defect in FFA metabolism is proportionate to the magnitude of hyperglycemia and occurs despite the presence of elevated levels of plasma insulin. These results are consistent with the view that insulin resistance in NIDDM also involves the ability of insulin to regulate FFA metabolism.
在15名正常受试者和15名非胰岛素依赖型糖尿病（NIDDM）患者中，于08:00至16:00测定血浆葡萄糖、胰岛素和游离脂肪酸（FFA）浓度。早餐和午餐分别在08:00和12:00食用，并在08:00至16:00每隔一小时测量血浆浓度。NIDDM患者在08:00至16:00之间的血浆葡萄糖浓度显著升高，空腹血糖水平越高，餐后高血糖越严重。NIDDM患者的高血糖与血浆胰岛素水平显著高于正常受试者（P<0.001）有关，轻度NIDDM患者（空腹血浆葡萄糖浓度<140mg/dl）在08:00至16:00之间出现大量高胰岛素血症。NIDDM患者的空腹和餐后FFA水平也升高（P<0.001），血浆葡萄糖反应越大，FFA反应越高（r = 0.70；P<0.001）。然而，血浆胰岛素和FFA浓度之间无显著相关性。更具体地说，轻度糖尿病（空腹血浆葡萄糖<140mg/dl）的高胰岛素血症患者维持正常的环境FFA水平，而重度NIDDM患者（空腹血浆葡萄糖>250mg/dl）的FFA浓度显著升高，胰岛素浓度与正常受试者相当。这些结果表明，NIDDM患者无法维持正常的血浆FFA浓度。FFA代谢的这种缺陷与高血糖的程度成正比，尽管血浆胰岛素水平升高仍会发生。这些结果与NIDDM中的胰岛素抵抗也涉及胰岛素调节FFA代谢能力的观点一致。
