Vialettes B, Zevaco-Mattei C, Thirion X, Lassmann-Vague V, Pieron H, Mercier P, Vague P
Department of Internal Medicine and Nutrition, University of Marseille, France.
Diabetes Care. 1993 Jul;16(7):973-7. doi: 10.2337/diacare.16.7.973.
To determine if knowledge of characteristics of insulin response to various secretagogues during the preclinical phase of type I diabetes may facilitate the diagnosis of subjects at risk.
A test consisting of sequential intravenous challenge with glucose (0.3 g/kg) and glucagon (1 mg, 10 min after the end of glucose injection) was performed on 171 ICA- relatives of type I diabetic patients, 18 ICA+ relatives of type I diabetic patients, and 5 transiently hyperglycemic subjects. Acute response to glucose was expressed as the sum of plasma insulin at 2 and 5 min and response to glucagon as the increase in plasma insulin after 10 min.
Responses below the lower 95% confidence interval in the ICA- population (40 and 43 microU/ml for glucose and glucagon, respectively) were considered abnormal. The two values were correlated (r = 0.62). Abnormalities coexisted in 2.3% of the ICA- group, 11% of the ICA+ group, and 100% of the transiently hyperglycemic group. All the relatives who subsequently developed diabetes or hyperglycemic subjects who required insulin exhibited combined abnormalities. Some ICA- and ICA+ relatives were tested repeatedly over a follow-up period of 1.5-4 yr. Although the intraindividual coefficient of variation for the two responses was high (28 and 30%), values tended to run parallel in both ICA+ and ICA- relatives. In 2 patients monitored for 2 and 4 yr before diabetes developed, both responses declined at the same rate. In terms of prediction of diabetes, sensitivity of combined abnormalities was high (100%). But compared with the intravenous glucose tolerance test, improvement of specificity by the double challenge was not statistically significant.
Both insulin responses to glucose and glucagon are related. They depend on the secretory capacity of beta-cells and simultaneously become abnormal in the prediabetic phase.
确定在I型糖尿病临床前期了解各种促分泌素引起的胰岛素反应特征是否有助于诊断有风险的受试者。
对171名I型糖尿病患者的ICA阴性亲属、18名I型糖尿病患者的ICA阳性亲属和5名短暂性高血糖受试者进行了一项测试，该测试包括依次静脉注射葡萄糖（0.3 g/kg）和胰高血糖素（1 mg，在葡萄糖注射结束后10分钟）。对葡萄糖的急性反应表示为2分钟和5分钟时血浆胰岛素之和，对胰高血糖素的反应表示为10分钟后血浆胰岛素的增加量。
ICA阴性人群中低于95%置信区间下限的反应（葡萄糖和胰高血糖素分别为40和43微单位/毫升）被视为异常。这两个值具有相关性（r = 0.62）。异常情况在2.3%的ICA阴性组、11%的ICA阳性组和100%的短暂性高血糖组中同时存在。所有随后发展为糖尿病的亲属或需要胰岛素治疗的高血糖受试者均表现出联合异常。一些ICA阴性和ICA阳性亲属在1.5至4年的随访期内进行了多次测试。尽管两种反应的个体内变异系数较高（分别为28%和30%），但ICA阳性和ICA阴性亲属的值倾向于平行变化。在糖尿病发生前接受2年和4年监测的2名患者中，两种反应以相同的速率下降。就糖尿病预测而言，联合异常的敏感性较高（100%）。但与静脉葡萄糖耐量试验相比，双重激发试验在特异性方面的改善无统计学意义。
胰岛素对葡萄糖和胰高血糖素的反应均相关。它们取决于β细胞的分泌能力，并且在糖尿病前期同时变得异常。
