Schulz B, Ratzmann K P, Heinke P, Besch W
Exp Clin Endocrinol. 1983 Aug;82(2):222-31. doi: 10.1055/s-0029-1210280.
Several studies have indicated that the long-term effectiveness of sulfonylurea therapy in the treatment of type-II diabetics is due to a potentiation of insulin action. The present investigation was undertaken in order to elucidate whether or not there is also an acute effect of sulfonylureas on insulin-mediated glucose uptake. Nine non-obese subjects classified as having impaired glucose tolerance formed the study group. In vivo insulin sensitivity was assessed by using the glucose controlled insulin infusion system (Biostator) without or with a contemporary 3-hour tolbutamide infusion. Studies were performed on subsequent days, and each subject served as its own control. Glucose was given at a fixed rate of 0.011 mmol/kg b.w./min. The computer program was set to maintain plasma glucose concentration at 3.89 mmol/l. The amount of exogenous insulin necessary to keep glycemia at this steady-state level has been accepted as an estimate of insulin sensitivity. Mean plasma glucose and insulin concentrations were constant and comparable in control and sulfonylurea treated groups. Under our experimental conditions tolbutamide did not provoke any increase of C-peptide secretion. There was no significant alteration of insulin counterregulatory hormones (glucagon and growth hormone) either. On the other hand, for the disposal of identical quantities of glucose the necessary amount of insulin has been found to be reduced by one third due to tolbutamide treatment indicating a higher insulin sensitivity. The mechanism by which tolbutamide intensifies the insulin effect is unknown. It seems to be that a successful short-term sulfonylurea therapy on glucose utilization is associated with some alterations on the receptor and/or post-receptor level.
多项研究表明，磺脲类药物治疗II型糖尿病的长期疗效归因于胰岛素作用的增强。本研究旨在阐明磺脲类药物对胰岛素介导的葡萄糖摄取是否也有急性作用。9名被归类为糖耐量受损的非肥胖受试者组成了研究组。使用葡萄糖控制胰岛素输注系统（生物人工肾）在无或同时进行3小时甲苯磺丁脲输注的情况下评估体内胰岛素敏感性。研究在随后的几天进行，每个受试者作为自身对照。以0.011 mmol/kg体重/分钟的固定速率给予葡萄糖。计算机程序设置为将血浆葡萄糖浓度维持在3.89 mmol/l。将维持血糖在该稳态水平所需的外源性胰岛素量作为胰岛素敏感性的估计值。对照组和磺脲类药物治疗组的平均血浆葡萄糖和胰岛素浓度恒定且具有可比性。在我们的实验条件下，甲苯磺丁脲未引起C肽分泌增加。胰岛素反向调节激素（胰高血糖素和生长激素）也没有明显变化。另一方面，由于甲苯磺丁脲治疗，发现处理相同量葡萄糖所需的胰岛素量减少了三分之一，这表明胰岛素敏感性更高。甲苯磺丁脲增强胰岛素作用的机制尚不清楚。似乎短期成功的磺脲类药物治疗对葡萄糖利用与受体和/或受体后水平的某些改变有关。
