Nevalainen P I, Lahtela J T, Mustonen J, Pasternack A
Medical School, University of Tampere, Finland.
Perit Dial Int. 1996;16 Suppl 1:S288-91.
We evaluated in a cross-over manner the consequences of subcutaneously and intraperitoneally given insulin on glucose control, insulin sensitivity, and serum lipids in 8 type I diabetic patients on continuous ambulatory peritoneal dialysis (CAPD). The patients were treated with both subcutaneous and intraperitoneal insulin for at least three months. After each period, metabolic studies were performed. Despite significantly improved glycemic control (Hb A1c 10.00 +/- 0.38% after subcutaneous and 8.40 +/- 0.36% after intraperitoneal insulin, p = 0.01), serum lipids showed unfavorable changes. High-density lipoprotein (HDL)-cholesterol was significantly lower (1.28 +/- 0.18 mmol/L vs 0.88 +/- 0.06 mmol/L, p = 0.03) and low-density lipoprotein (LDL)/HDL-cholesterol ratio was higher (p = 0.025) during intraperitoneal insulin. Total cholesterol, LDL-cholesterol, and triglycerides were higher during intraperitoneal insulin administration. Severe hypoglycemic episodes were more common during subcutaneous than intraperitoneal insulin. It is concluded that, although intraperitoneal insulin administration offers significantly better glycemic control and insulin sensitivity than subcutaneous insulin, the effect of serum lipids is more disadvantageous possibly via a direct effect of insulin on the liver.
我们采用交叉方式评估了皮下注射和腹腔内注射胰岛素对8例接受持续性非卧床腹膜透析（CAPD）的I型糖尿病患者血糖控制、胰岛素敏感性和血脂的影响。患者皮下注射和腹腔内注射胰岛素均至少持续三个月。每个阶段结束后，进行代谢研究。尽管血糖控制有显著改善（皮下注射胰岛素后糖化血红蛋白[Hb A1c]为10.00±0.38%，腹腔内注射胰岛素后为8.40±0.36%，p = 0.01），但血脂出现了不利变化。腹腔内注射胰岛素期间，高密度脂蛋白（HDL）胆固醇显著降低（1.28±0.18 mmol/L对0.88±0.06 mmol/L，p = 0.03），低密度脂蛋白（LDL）/HDL胆固醇比值升高（p = 0.025）。腹腔内注射胰岛素期间，总胆固醇、LDL胆固醇和甘油三酯水平更高。皮下注射胰岛素期间严重低血糖发作比腹腔内注射胰岛素更常见。结论是，尽管腹腔内注射胰岛素在血糖控制和胰岛素敏感性方面比皮下注射胰岛素有显著更好的效果，但对血脂的影响可能通过胰岛素对肝脏的直接作用而更不利。
