Hoffman R P, Arslanian S, Drash A L, Becker D J
Department of Pediatrics, University of Pittsburgh.
J Pediatr Endocrinol. 1994 Jul-Sep;7(3):235-44. doi: 10.1515/jpem.1994.7.3.235.
Children with long-standing IDDM have impaired counterregulatory responses to hypoglycemia. To determine whether children with new onset IDDM also have altered counterregulation, we studied the counterregulatory responses to hypoglycemia in twenty children with new onset IDDM (5-6 days, age 12.6 +/- 2.9 yr, mean +/- SD), and compared these responses to 47 subjects with long-standing IDDM (duration 7.8 +/- 3.6 yr, age 15.3 +/- 2.5 yr) and 21 controls (age 14.2 +/- 2.8 yr). Six new onset subjects were restudied three months later during their remission. Glucose nadir in new onset (2.7 +/- 0.1 mmol.l-1) was similar to controls (2.4 +/- 0.1 mmol.l-1), but was higher than in long-standing IDDM (2.2 +/- 0.1 mmol.l-1). Both groups of diabetic subjects had lower glucagon responses to hypoglycemia than controls (p < 0.005). Glucagon responses in new and long-standing diabetes did not differ. Epinephrine was diminished in new IDDM compared to controls (p < 0.01). Glucose recovery was faster in new onset than in long-standing IDDM (p < 0.001) and the same as in controls. Responses remained diminished 3 months after diagnosis despite increased C-peptide and lower glycosylated hemoglobin. Thus, children with IDDM have diminished counterregulatory responses to hypoglycemia at diagnosis, that are similar to those in long-standing IDDM. The reasons for this impairment and its clinical application in childhood require further investigation.
患有长期胰岛素依赖型糖尿病（IDDM）的儿童对低血糖的反调节反应受损。为了确定新发病的IDDM儿童是否也存在反调节改变，我们研究了20名新发病的IDDM儿童（病程5 - 6天，年龄12.6 +/- 2.9岁，均值 +/- 标准差）对低血糖的反调节反应，并将这些反应与47名患有长期IDDM的受试者（病程7.8 +/- 3.6年，年龄15.3 +/- 2.5岁）和21名对照者（年龄14.2 +/- 2.8岁）进行比较。6名新发病的受试者在三个月后的缓解期再次接受研究。新发病者的最低血糖值（2.7 +/- 0.1 mmol.l-1）与对照者（2.4 +/- 0.1 mmol.l-1）相似，但高于长期IDDM患者（2.2 +/- 0.1 mmol.l-1）。两组糖尿病受试者对低血糖的胰高血糖素反应均低于对照者（p < 0.005）。新发病和长期糖尿病患者的胰高血糖素反应无差异。与对照者相比，新发病的IDDM患者肾上腺素减少（p < 0.01）。新发病者的血糖恢复比长期IDDM患者快（p < 0.001），且与对照者相同。尽管C肽增加且糖化血红蛋白降低，但诊断后3个月反应仍减弱。因此，IDDM儿童在诊断时对低血糖的反调节反应减弱，这与长期IDDM患者相似。这种损害的原因及其在儿童期的临床应用需要进一步研究。
