Giugliano D, Di Pinto P, Ceriello A, Paolisso G, Saccomanno F, Torella R, D'Onofrio F
Acta Diabetol Lat. 1985 Jul-Sep;22(3):203-13. doi: 10.1007/BF02590771.
Insulin secretory responses to both oral and intravenous glucose were investigated in 12 nonobese noninsulin-dependent diabetic subjects before and after strict metabolic control of blood glucose levels without weight loss. Glycemic control was achieved by applying an artificial pancreas to all diabetics for 2 or 3 days, which led to restoration of normal fasting blood glucose levels and to significant reduction of fasting plasma insulin (p less than 0.01) and C-peptide (p less than 0.05) levels. Initially, the insulin response to oral glucose was weak and delayed, but increased significantly after treatment (p less than 0.01), although none of the diabetic subjects achieved completely normal glucose tolerance. The i.v. glucose tolerance test (0.33 g/kg) revealed that all diabetics lacked acute insulin response in the basal state with low glucose disappearance rates (0.37 +/- 0.07 %/min). After 48h of normoglycemia, these figures did not change significantly, although the insulinogenic index (insulin area/glucose area) was significantly increased (p less than 0.05). A marked increase in both phases of insulin secretion was evident when a larger intravenous glucose pulse (0.66 g/kg) was used in some diabetics in order to raise the blood glucose concentrations of the post-treatment test to those of the pre-treatment test. In absolute terms, the insulin responses of the post-treatment tests were not significantly different from those of sex-, age- and weight-matched control subjects, but were significantly lower if related to the corresponding plasma glucose responses (insulinogenic index lower than that of controls). These studies in nonobese noninsulin-dependent diabetic subjects indicate that glycemic control with an artificial pancreas improves insulin response to glucose, suggesting that chronic hyperglycemia may stress the impaired B-cell secretory capacity of diabetes.
在12名非肥胖型非胰岛素依赖型糖尿病患者中，在严格控制血糖水平且体重未减轻的情况下，研究了口服和静脉注射葡萄糖后的胰岛素分泌反应。通过对所有糖尿病患者应用人工胰腺2至3天来实现血糖控制，这导致空腹血糖水平恢复正常，空腹血浆胰岛素（p<0.01）和C肽（p<0.05）水平显著降低。最初，口服葡萄糖后的胰岛素反应较弱且延迟，但治疗后显著增加（p<0.01），尽管没有糖尿病患者达到完全正常的糖耐量。静脉葡萄糖耐量试验（0.33g/kg）显示，所有糖尿病患者在基础状态下缺乏急性胰岛素反应，葡萄糖消失率较低（0.37±0.07%/分钟）。在血糖正常48小时后，这些数值没有显著变化，尽管胰岛素生成指数（胰岛素面积/葡萄糖面积）显著增加（p<0.05）。当对一些糖尿病患者使用较大的静脉葡萄糖脉冲（0.66g/kg）以使治疗后试验的血糖浓度恢复到治疗前试验的水平时，胰岛素分泌的两个阶段均明显增加。绝对而言，治疗后试验的胰岛素反应与性别、年龄和体重匹配的对照受试者的反应没有显著差异，但与相应的血浆葡萄糖反应相关时则显著较低（胰岛素生成指数低于对照组）。这些对非肥胖型非胰岛素依赖型糖尿病患者的研究表明，人工胰腺控制血糖可改善胰岛素对葡萄糖的反应，提示慢性高血糖可能会加重糖尿病患者受损的β细胞分泌能力。
