Matsumoto K, Akazawa S, Abiru N, Yano M, Ishibasi M, Uotani S, Matsuo H, Kawasaki E, Yamasaki H, Yamamoto H
First Department of Internal Medicine, Nagasaki University School of Medicine, Japan.
Diabetes Res Clin Pract. 1994 Dec 16;26(2):129-35. doi: 10.1016/0168-8227(94)90150-3.
We investigated the relationship between the improvement in insulin secretion and glycemic control in non-insulin-dependent diabetes mellitus (NIDDM). Fifty-two patients were classified into three groups according to their pretreatment fasting plasma glucose (FPG) level: Group A, FPG < 7.8 mM, n = 20; Group B, 7.8 mM < or = FPG < 11.1 mM, n = 17; and Group C, 11.1 mM < or = FPG, n = 15. A 75-g oral glucose tolerance test (OGTT) and a glucagon loading test were performed to evaluate insulin secretion before and after treatment. Plasma glucose levels during a 75-g OGTT were decreased significantly after treatment in all groups (P < 0.01). In Group A, there was no significant change in insulin secretion before and after treatment (1466 +/- 213 pM to 1565 +/- 191 pM, P = 0.35). In contrast, in Groups B and C, insulin secretion was poor and suppressed initially, but increased significantly when good glycemic control was obtained after treatment (respectively, 587 +/- 70 pM to 863 +/- 79 pM, P < 0.01, and 621 +/- 94 pM to 1236 +/- 232 pM, P < 0.01). The degree of improvement in insulin secretion in 75-g OGTT correlated positively with the degree of improvement in FPG level after treatment (r = 0.5, P < 0.001). However, the C-peptide response to glucagon did not change before and after treatment. In conclusion, impaired insulin secretion recovered by the good glycemic control in NIDDM with FPG levels above 7.8 mM. Therefore, strict glycemic control (FPG below 7.8 mM) seems important for maintaining good insulin secretion.
我们研究了非胰岛素依赖型糖尿病（NIDDM）患者胰岛素分泌改善与血糖控制之间的关系。52例患者根据治疗前空腹血糖（FPG）水平分为三组：A组，FPG<7.8 mM，n = 20；B组，7.8 mM≤FPG<11.1 mM，n = 17；C组，11.1 mM≤FPG，n = 15。进行75克口服葡萄糖耐量试验（OGTT）和胰高血糖素负荷试验以评估治疗前后的胰岛素分泌。所有组治疗后75克OGTT期间的血糖水平均显著降低（P<0.01）。A组治疗前后胰岛素分泌无显著变化（1466±213 pM至1565±191 pM，P = 0.35）。相比之下，B组和C组胰岛素分泌较差且最初受到抑制，但治疗后血糖得到良好控制时显著增加（分别为587±70 pM至863±79 pM，P<0.01，以及621±94 pM至1236±232 pM，P<0.01）。75克OGTT中胰岛素分泌的改善程度与治疗后FPG水平的改善程度呈正相关（r = 0.5，P<0.001）。然而，胰高血糖素刺激后的C肽反应治疗前后未发生变化。总之，FPG水平高于7.8 mM的NIDDM患者通过良好的血糖控制可使受损的胰岛素分泌恢复。因此，严格的血糖控制（FPG低于7.8 mM）对于维持良好的胰岛素分泌似乎很重要。
