Valensi P, Moura I, Le Magoarou M, Pariès J, Perret G, Attali J R
Service d'Endocrinologie-Diabétologie-Nutrition, Hôpital Jean Verdier, Bondy, France.
Diabetes Metab. 1997 Feb;23(1):51-7.
It is difficult to treat obese non-insulin-dependent diabetic patients (NIDDs) whose glycaemic control remains poor despite maximal oral antidiabetic therapy. We studied the effect of a continuous subcutaneous insulin infusion (CSII) associated with a low-calorie diet and metformin 1,700 mg/day on glycaemic control and basal and stimulated insulin secretion in a series of 82 overweight NIDD before (T1), during CSII (T2), and after CSII withdrawal (T3). Patients were treated for 8 to 23 days with a mean amount of 0.50 +/- 0.02 IU/kg/day. Glycaemic control was very good after 3-5 days of CSII and remained good at T3. At T2, fasting and postprandial plasma C peptide levels decreased significantly. At T3, fasting C peptide was very similar to T1, and postprandial C peptide was significantly higher than at T1. The molar fasting and postprandial plasma C peptide/glycaemia ratios increased significantly at T3. After glucagon injection, the molar delta C peptide/glycaemia ratio was significantly increased at T2 and even higher at T3. At T2, as at T1 and T3, there were significant correlations between fasting and postprandial C peptide levels and between the glucagon-induced C peptide peak and fasting and postprandial C peptide levels. Between T1 and T3 weight changes correlated significantly with the molar fasting C peptide/glycaemia ratio at T1. Twenty-nine of the 30 patients for whom this ratio was > 6.6 x 10(-8) lost weight. The length of CSII treatment did not correlate with weight changes or other biological parameters. This study shows that CSII with moderate amounts of insulin associated with a low-calorie diet and metformin provided rapid glycaemic control, led to weight loss, maintained regulation of insulin secretion and seemed to improve insulin secretion and sensitivity. These results were obtained in only 8 to 10 days.
对于那些尽管接受了最大剂量口服抗糖尿病治疗但血糖控制仍差的肥胖非胰岛素依赖型糖尿病患者（NIDDs）而言，治疗颇具难度。我们研究了连续皮下胰岛素输注（CSII）联合低热量饮食及每日1700毫克二甲双胍，对82例超重NIDD患者在治疗前（T1）、CSII治疗期间（T2）及CSII撤药后（T3）的血糖控制以及基础和刺激后胰岛素分泌的影响。患者接受了8至23天的治疗，平均剂量为0.50±0.02国际单位/千克/天。CSII治疗3至5天后血糖控制良好，且在T3时仍保持良好。在T2时，空腹和餐后血浆C肽水平显著下降。在T3时，空腹C肽与T1时非常相似，餐后C肽显著高于T1。在T3时，空腹和餐后血浆C肽/血糖的摩尔比显著增加。注射胰高血糖素后，T2时C肽/血糖的摩尔增量比显著增加，在T3时更高。在T2时，与T1和T3时一样，空腹和餐后C肽水平之间以及胰高血糖素诱导C肽峰值与空腹和餐后C肽水平之间存在显著相关性。在T1和T3之间，体重变化与T1时空腹C肽/血糖的摩尔比显著相关。该比值>6.6×10⁻⁸的30例患者中有29例体重减轻。CSII治疗的时长与体重变化或其他生物学参数无关。本研究表明，中等剂量胰岛素的CSII联合低热量饮食和二甲双胍可实现快速血糖控制，导致体重减轻，维持胰岛素分泌调节，且似乎能改善胰岛素分泌和敏感性。这些结果在仅8至10天内就得以实现。
