在未控制的2型糖尿病亚洲印度患者中，不吃早餐期间，介导午餐后较高血糖波动的是胰高血糖素，而非胰高血糖素样肽1。
Glucagon, rather than Glucagon-Like Peptide 1, Mediates Higher Post-Lunch Glucose Excursions during Breakfast Skipping in Asian Indian Patients with Uncontrolled Type 2 Diabetes Mellitus.
作者信息
Chauhan Yash V, Hakke Mahesh D, Sanamandra Prudwiraj, Gada Jugal V, Misra Sukirti, Rahate Sachin S, Varekar Namrata, Palekar Anagha V, Varthakavi Premlata K, Bhagwat Nikhil M
机构信息
Department of Endocrinology, Bai Yamunabai Laxman Nair Charitable Hospital and Topiwala National Medical College, Mumbai, Maharashtra, India.
Department of Dietetics, Bai Yamunabai Laxman Nair Charitable Hospital and Topiwala National Medical College, Mumbai, Maharashtra, India.
出版信息
Indian J Endocrinol Metab. 2024 Nov-Dec;28(6):645-652. doi: 10.4103/ijem.ijem_295_24. Epub 2024 Dec 30.
INTRODUCTION
The effect and mechanism of skipping breakfast on glycemic control in type 2 diabetes mellitus (T2DM) in Asian-Indians is unknown.
METHODS
Cross-over, within-group study recruiting 5 habitual breakfast eaters (BE) and 5 habitual breakfast skippers (BS) with uncontrolled T2DM (HbA1c 7-9%). Patients underwent testing after three days of following their usual breakfast habits and after seven days of crossing over to the other arm. Fasting values and incremental area under the curve (iAUC) of post-lunch levels of glucose, insulin, C-peptide, glucagon-like peptide 1 (GLP-1), and glucagon were measured. Continuous glucose monitoring (CGM) parameters assessed were area under the curve (AUC) of post-meal glucose values, 24-hour average blood glucose (ABG), time in range (TIR), and glycemic variability.
RESULTS
BS led to significantly higher fasting (133.5 ± 34.5 mg/dl vs 110 ± 31.50 mg/dl, = 0.009) and peak post-lunch (214.6 ± 35.07 mg/dl vs 175.4 ± 39.26 mg/dl, < 0.001) plasma glucose, and HOMA-IR (3.05 ± 3.89 vs 2.03 ± 1.76, = 0.007) as compared to BE. Post-lunch iAUC during BS was significantly higher for plasma glucose (7623 ± 2947.9 mg/dl × min vs 1922.4 ± 1902.1 mg/dl × min, < 0.001), insulin (2460 ± 1597.50 mIU/ml × mins vs 865.71 ± 1735.73 mIU/ml × mins, = 0.028), C-peptide (418.4 ± 173.4 ng/ml × mins vs 127.8 ± 117.1 ng/ml × mins, < 0.001) and glucagon (7272.7 ± 4077 pg/ml × mins vs 4568.8 ± 2074.9 pg/ml × mins, = 0.044) as compared to BE, while GLP-1 (1812.7 ± 883 pmol/l × mins during BS vs 1643 ± 910 pmol/l × mins during BE, = 0.255) did not significantly differ between the two visits. CGM revealed a higher post-lunch AUC during BS. There was no difference in post-dinner AUC, ABG, TIR, or glycemic variability.
CONCLUSION
Skipping breakfast led to higher post-lunch glucose excursions, possibly due to higher glucagon excursion and increased insulin resistance.
引言
在亚洲印度人中，不吃早餐对2型糖尿病（T2DM）患者血糖控制的影响及机制尚不清楚。
方法
采用交叉、组内研究，招募5名习惯吃早餐者（BE）和5名习惯不吃早餐者（BS），他们均为T2DM控制不佳（糖化血红蛋白7%-9%）的患者。患者先按照其通常的早餐习惯进食3天后进行检测，然后交叉到另一组，再经过7天的饮食后进行检测。测量午餐后血糖、胰岛素、C肽、胰高血糖素样肽1（GLP-1）和胰高血糖素的空腹值及曲线下增量面积（iAUC）。评估的连续血糖监测（CGM）参数包括餐后血糖值曲线下面积（AUC）、24小时平均血糖（ABG）、血糖达标时间（TIR）和血糖变异性。
结果
与BE相比，BS导致空腹血糖（133.5±34.5mg/dl对110±31.50mg/dl，P = 0.009）和午餐后血糖峰值（214.6±35.07mg/dl对175.4±39.26mg/dl，P<0.001）显著升高，且稳态模型评估的胰岛素抵抗（HOMA-IR）升高（3.05±3.89对2.03±1.76，P = 0.007）。与BE相比，BS期间午餐后血浆葡萄糖（7623±2947.9mg/dl×min对1922.4±1902.1mg/dl×min，P<0.001）、胰岛素（2460±1597.50mIU/ml×min对865.71±1735.73mIU/ml×min，P = 0.028）、C肽（418.4±173.4ng/ml×min对127.8±117.1ng/ml×min，P<0.001）和胰高血糖素（7272.7±4077pg/ml×min对4568.8±2074.9pg/ml×min，P = 0.044）的iAUC显著升高，而GLP-1在两次检查之间无显著差异（BS期间为1812.7±883pmol/l×min，BE期间为1643±910pmol/l×min，P = 0.255）。CGM显示BS期间午餐后AUC更高。晚餐后AUC、ABG、TIR或血糖变异性无差异。
结论
不吃早餐导致午餐后血糖波动更大，可能是由于胰高血糖素波动更大和胰岛素抵抗增加所致。
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