Castillo M J, Scheen A J, Lefebvre P J
Department of Medicine, CHU Liège, Belgium.
Rev Esp Fisiol. 1994 Mar;50(1):27-34.
The metabolic clearance rate of insulin (MCRI) in 10 non-obese type 2 diabetic patients treated with either insulin alone or combined insulin plus sulfonylurea therapy is investigated. A classical 2-hour euglycaemic hyperinsulinaemic glucose clamp using the artificial pancreas was performed in a randomized order after two 6-week periods of treatment: either with subcutaneous injections of insulin alone or with insulin plus oral administration of the sulfonylurea compound glipizide at the dose of 3 x 10 mg/day. The MCRI was calculated knowing the constant insulin infusion rate (0.1 U.kg-1.h-1) and measuring basal and steady-state plasma free insulin and C-peptide levels. When the test was performed at the end of the period of treatment with insulin plus glipizide and 30 min after the ingestion of the last dose of 10 mg glipizide, plasma C-peptide levels were significantly increased and steady-state free insulin levels tended to be slightly higher whereas the metabolic clearance rate of glucose was not affected. The MCRI was significantly reduced by glipizide from 23.3 +/- 2.9 to 18.9 +/- 2.0 ml.kg-1.min-1 p < 0.05. These results demonstrate that the sulfonylurea glipizide decreases the MCRI. This effect may play a role in the hypoglycemic action of sulfonylureas.
对10例非肥胖型2型糖尿病患者单独使用胰岛素或胰岛素联合磺脲类药物治疗时的胰岛素代谢清除率（MCRI）进行了研究。在两个为期6周的治疗期后，采用人工胰腺以随机顺序进行经典的2小时正常血糖高胰岛素葡萄糖钳夹试验：一个治疗期为皮下单独注射胰岛素，另一个治疗期为胰岛素联合口服剂量为3×10mg/天的磺脲类化合物格列吡嗪。在已知恒定胰岛素输注速率（0.1U·kg-1·h-1）并测量基础和稳态血浆游离胰岛素及C肽水平的情况下计算MCRI。当在胰岛素加格列吡嗪治疗期结束时且在摄入最后一剂10mg格列吡嗪30分钟后进行试验时，血浆C肽水平显著升高，稳态游离胰岛素水平趋于略高，而葡萄糖代谢清除率未受影响。格列吡嗪使MCRI从23.3±2.9显著降低至18.9±2.0ml·kg-1·min-1，p<0.05。这些结果表明磺脲类药物格列吡嗪降低了MCRI。这种作用可能在磺脲类药物的降糖作用中发挥作用。
