Perriello G, Pampanelli S, Del Sindaco P, Lalli C, Ciofetta M, Volpi E, Santeusanio F, Brunetti P, Bolli G B
Dipartimento di Medicina Interna e Scienze Endocrine e Metaboliche, Università di Perugia, Italy.
Diabetes. 1997 Jun;46(6):1010-6. doi: 10.2337/diab.46.6.1010.
To assess the mechanisms of fasting hyperglycemia in NIDDM patients with mild elevation of fasting plasma glucose (FPG) compared with NIDDM patients with overt hyperglycemia, we studied 29 patients with NIDDM, who were divided in two groups according to their fasting plasma glucose (<7.8 and > or =7.8 mmol/l for groups A and B, respectively), and 16 control subjects who were matched with NIDDM patients for age, sex, and body mass index. All subjects were infused with [3-3H]glucose between 10:00 P.M. and 10:00 A.M. during overnight fasting to determine glucose fluxes. In 27 subjects (17 diabetic and 10 control), [U-14C]alanine was simultaneously infused between 4:00 A.M. and 10:00 A.M. to measure gluconeogenesis (GNG) from alanine. Arterialized-venous plasma samples were collected every 30 min for measurement of glucose fluxes, GNG, and glucoregulatory hormones. In group A, plasma glucose, rate of systemic glucose production (SGP), and GNG were greater than in control subjects (7.2 +/- 0.2 vs. 4.9 +/- 0.1 mmol/l, 10.9 +/- 0.2 vs. 9.5 +/- 0.3 micromol x kg(-1) x min(-1), and 0.58 +/- 0.04 vs. 0.37 +/- 0.02 micromol x kg(-1) x min(-1), respectively, for group A and control subjects; mean value 8:00 A.M.-10:00 A.M., all P < 0.05). Both increased SGP and GNG correlated with plasma glucose in all subjects (r = 0.77 and r = 0.75, respectively, P < 0.005). Plasma counterregulatory hormones did not differ in NIDDM patients compared to control subjects. The present studies demonstrate that SGP and GNG are increased in NIDDM patients without overt fasting hyperglycemia. Thus these metabolic abnormalities primarily contribute to early development of overnight and fasting hyperglycemia in NIDDM.
为了评估空腹血糖轻度升高的非胰岛素依赖型糖尿病（NIDDM）患者与明显高血糖的NIDDM患者相比出现空腹高血糖的机制，我们研究了29例NIDDM患者，根据其空腹血糖水平将他们分为两组（A组空腹血糖<7.8 mmol/l，B组空腹血糖≥7.8 mmol/l），并选取了16名在年龄、性别和体重指数方面与NIDDM患者相匹配的对照者。所有受试者在夜间禁食期间于晚上10点至次日上午10点输注[3-3H]葡萄糖以测定葡萄糖通量。在27名受试者（17名糖尿病患者和10名对照者）中，于凌晨4点至上午10点同时输注[U-14C]丙氨酸以测量丙氨酸的糖异生（GNG）。每30分钟采集一次动脉化静脉血浆样本以测量葡萄糖通量、GNG和葡萄糖调节激素。A组的血浆葡萄糖、全身葡萄糖生成率（SGP）和GNG均高于对照者（A组和对照者分别为7.2±0.2 vs. 4.9±0.1 mmol/l、10.9±0.2 vs. 9.5±0.3 μmol·kg-1·min-1、0.58±0.04 vs. 0.37±0.02 μmol·kg-1·min-1；上午8点至10点的平均值，所有P<0.05）。所有受试者中SGP和GNG的增加均与血浆葡萄糖相关（r分别为0.77和0.75，P<0.005）。与对照者相比，NIDDM患者的血浆对抗调节激素无差异。目前的研究表明，在无明显空腹高血糖的NIDDM患者中SGP和GNG增加。因此，这些代谢异常主要促成了NIDDM患者夜间和空腹高血糖的早期发展。
