Kerner W, Moll H, Navascués I, Pfeiffer E F
Klin Wochenschr. 1984 Aug 1;62(15):738-44. doi: 10.1007/BF01725708.
In nine insulin-dependent diabetics postprandial glucose control under closed loop insulin infusion by an artificial endocrine pancreas was compared with that obtained under open loop infusion employing identical infusion profiles which were advanced 20 min by time in the case of open loop infusion. The earlier increase of insulin infusion rates in the latter case resulted in lower postprandial glucose concentrations during the first 90 min after meal intake. Incremental areas under the blood glucose curves during this time were significantly lower when insulin infusion rates rose earlier (4.5 X 10(3) +/- 0.5 X 10(3) vs 2.1 X 10(3) +/- 0.6 X 10(3) mg/dl X min; p less than 0.02). Insulin was administered at maximum rates 45-50 min after the start of the meal during closed loop infusion (196 +/- 38 mU/min) and 25-30 min after the meal during open loop infusion (192 +/- 35 mU/min). Correspondingly, mean free insulin concentrations which are available from six patients rose to 135 +/- 47 (40 min) or 141 +/- 50 muU/ml (20 min). Glucagon levels did not differ between both parts of the study. It is concluded that increases of postprandial insulin infusion rates occurring earlier than increases of blood glucose levels are important for optimizing glucose profiles and possibly reflect physiologic conditions.
在9名胰岛素依赖型糖尿病患者中，比较了人工内分泌胰腺闭环胰岛素输注下的餐后血糖控制情况与开环输注下的餐后血糖控制情况，开环输注采用相同的输注曲线，但输注时间提前20分钟。在后一种情况下，胰岛素输注速率更早增加，导致餐后90分钟内餐后血糖浓度更低。当胰岛素输注速率更早上升时，这段时间内血糖曲线下的增量面积显著更低（4.5×10³±0.5×10³对2.1×10³±0.6×10³mg/dl×分钟；p<0.02）。在闭环输注期间，胰岛素在餐后开始45 - 50分钟时以最大速率给药（196±38mU/分钟），在开环输注期间，胰岛素在餐后25 - 30分钟时以最大速率给药（192±35mU/分钟）。相应地，6名患者的平均游离胰岛素浓度升至135±47（40分钟）或141±50μU/ml（20分钟）。研究的两个部分之间胰高血糖素水平没有差异。得出的结论是，餐后胰岛素输注速率的增加早于血糖水平的增加对于优化血糖曲线很重要，并且可能反映了生理状况。
