Bowen H F, Moorhouse J A
J Clin Invest. 1973 Dec;52(12):3033-45. doi: 10.1172/JCI107502.
The glucose turnover rate in maturity-onset diabetes in man has been variously reported as increased, normal, and decreased. The present experiments suggest that these discrepancies may have been due to methodology, and to nonrecognition of a circadian cycle in the glucose turnover rate that is present in health, and marked in diabetes. During the early morning hours the glucose turnover rate in maturity-onset diabetes is increased in proportion to the fasting blood glucose level. It may reach three to four times the rate found in health. During the evening hours the increments are about one-half as great. The glucose outflow rate constant, k, lower in diabetes than in health, is also lower in both groups in the evening than in the morning. An analysis of the relative contributions of glucose overproduction and underutilization to the development of hyperglycemia in maturity-onset diabetes indicates that overproduction is the greater factor. The relative role of underutilization appears to increase as the fasting blood glucose level increases. The circulating glucose oxidation rate in maturity-onset diabetes is only slightly lower than in health, but the fraction oxidized is markedly lower, and only a small fraction is excreted. The principal conclusion is that in maturity-onset diabetes there is a hypertrophied flux of endogenous glucose, most of which is neither oxidized nor excreted. The precursors and the qualitative and quantitative metabolic fates of this excess glucose are unknown.
关于成年型糖尿病患者的葡萄糖转换率，文献报道不一，有升高、正常和降低等不同情况。目前的实验表明，这些差异可能是由于方法学问题，以及未认识到健康人存在的葡萄糖转换率昼夜节律，而糖尿病患者这种节律更为明显。在清晨时段，成年型糖尿病患者的葡萄糖转换率与空腹血糖水平成比例增加，可能达到健康人水平的三到四倍。在傍晚时段，增加幅度约为清晨的一半。糖尿病患者的葡萄糖流出速率常数k低于健康人，且两组在傍晚时均低于清晨。对成年型糖尿病患者高血糖发生过程中葡萄糖过度生成和利用不足的相对作用分析表明，过度生成是更主要的因素。随着空腹血糖水平升高，利用不足的相对作用似乎增加。成年型糖尿病患者的循环葡萄糖氧化率仅略低于健康人，但氧化部分明显更低，且只有一小部分被排泄。主要结论是，成年型糖尿病患者存在内源性葡萄糖通量增大的情况，其中大部分既未被氧化也未被排泄。这种过量葡萄糖的前体以及其定性和定量代谢归宿尚不清楚。
