腹膜透析以及皮下和腹膜内胰岛素的使用对1型糖尿病患者糖代谢和血脂的影响。

The influence of peritoneal dialysis and the use of subcutaneous and intraperitoneal insulin on glucose metabolism and serum lipids in type 1 diabetic patients.

作者信息

Nevalainen P, Lahtela J T, Mustonen J, Pasternack A

机构信息

Department of Medicine, University of Tampere, Finland.

出版信息

Nephrol Dial Transplant. 1997 Jan;12(1):145-50. doi: 10.1093/ndt/12.1.145.

DOI:10.1093/ndt/12.1.145

PMID:9027790

Abstract

BACKGROUND

Intraperitoneally administered insulin is regarded as the most physiological replacement therapy, leading to lower peripheral insulin concentrations and equal or better glycaemic control than subcutaneous insulin. This two-part study was undertaken to evaluate the effect of CAPD, as well as the use of subcutaneous vs. intraperitoneal insulin on insulin sensitivity, glycaemic control and serum lipids in type 1 diabetes.

METHODS

Eleven patients with type 1 diabetes mellitus and chronic renal failure participated the studies. Glycated haemoglobin (HbA1c), euglycaemic hyperin-sulinaemic clamp, serum lipids, and patient well-being were measured. During CAPD all patients were first treated with subcutaneous insulin and then with intraperitoneal insulin. The metabolic studies were repeated after both treatment periods for at least 3 months. Metabolic studies were performed on six of the patients also before initiation of CAPD.

RESULTS

HbA1c rose after the initiation of CAPD from 8.85 +/- 0.54% to 9.58 +/- 0.66%, NS) and improved after changing from subcutaneous to intraperitoneally administered insulin (from 9.49 +/- 0.43% to 8.13 +/- 0.39%, P < 0.01). Insulin dose increased by 15% after initiation of CAPD and 128% after switching from subcutaneous to intraperitoneal insulin. Glucose disposal rate enhanced by 39% (P = 0.05) and 14% respectively (P < 0.01). Initiation of CAPD had no significant effects on serum lipids but intraperitoneally administered insulin reduced HDL cholesterol and increased LDL/HDL ratio significantly.

CONCLUSIONS

Intraperitoneal insulin therapy offers better glycaemic control and insulin sensitivity than subcutaneous insulin. Deterioration of HbA1c after initiation of CAPD while patients remained on subcutaneous insulin may be partly due to absorbed energy from the dialysate. Intraperitoneal insulin therapy seems to have detrimental effects on serum lipids. The clinical significance in modifying the risk of atherosclerosis remains unclear.

摘要

背景

腹腔内注射胰岛素被认为是最符合生理的替代疗法，与皮下注射胰岛素相比，它能降低外周胰岛素浓度，实现同等或更好的血糖控制。这项分为两部分的研究旨在评估持续性非卧床腹膜透析（CAPD）以及皮下注射与腹腔内注射胰岛素对1型糖尿病患者胰岛素敏感性、血糖控制和血脂的影响。

方法

11例1型糖尿病合并慢性肾衰竭患者参与了这些研究。测量了糖化血红蛋白（HbA1c）、正常血糖高胰岛素钳夹试验、血脂以及患者的健康状况。在CAPD期间，所有患者首先接受皮下胰岛素治疗，然后接受腹腔内胰岛素治疗。两个治疗期均持续至少3个月，之后重复进行代谢研究。在开始CAPD之前，也对其中6例患者进行了代谢研究。

结果

开始CAPD后，HbA1c从8.85±0.54%升至9.58±0.66%（无显著性差异），从皮下注射胰岛素改为腹腔内注射胰岛素后有所改善（从9.49±0.43%降至8.13±0.39%，P<0.01）。开始CAPD后胰岛素剂量增加了15%，从皮下注射改为腹腔内注射胰岛素后增加了128%。葡萄糖处置率分别提高了39%（P=0.05）和14%（P<0.01）。开始CAPD对血脂无显著影响，但腹腔内注射胰岛素显著降低了高密度脂蛋白胆固醇并提高了低密度脂蛋白/高密度脂蛋白比值。