Lindström T, Leckström A, Westermark P, Arnqvist H J
Department of Internal Medicine, Faculty of Health Sciences, The University Hospital, Linköping, Sweden.
Diabet Med. 1997 Jun;14(6):472-6. doi: 10.1002/(SICI)1096-9136(199706)14:6<472::AID-DIA388>3.0.CO;2-Q.
The objective was to evaluate the effect of insulin treatment on circulating islet amyloid polypeptide (IAPP). Twelve patients with NIDDM and secondary failure were studied on oral agents and then switched to insulin treatment. Fasting and postprandial IAPP concentrations were measured on oral treatment and on insulin treatment. In 5 of the patients no postprandial concentrations were determined. In the 7 patients who were investigated both fasting and postprandially the fasting IAPP concentration was 6.5 +/- 1.2 pmol l(-1) (mean +/- SEM) during oral treatment with a rise to 13.5 +/- 3.1 90 min after breakfast (p = 0.028). On insulin treatment HbA1c decreased from 8.6 +/- 0.5 to 7.5 +/- 0.4% (p< 0.03) and plasma C-peptide concentration was significantly lowered (p< 0.01). There was a close correlation using simple regression between the per cent change of IAPP concentration and the per cent change of C-peptide concentration during this period (r = 0.88; p< 0.01). In the total patient material of 12 patients there was a significant correlation using simple regression analysis between per cent change of IAPP concentration and per cent change of C-peptide concentration using all 48 measurements available (r = 0.58: p< 0.001). These data suggest that secretion of IAPP is lowered when endogenous insulin secretion is lowered by administration of exogenous insulin in patients with NIDDM. Thus, if IAPP secretion has a pathogenetic role in the development of beta cell failure in NIDDM, insulin treatment might delay this deterioration.
目的是评估胰岛素治疗对循环胰岛淀粉样多肽（IAPP）的影响。对12例非胰岛素依赖型糖尿病（NIDDM）且继发治疗失败的患者先采用口服降糖药治疗，随后改用胰岛素治疗。分别在口服治疗和胰岛素治疗阶段测定空腹及餐后IAPP浓度。5例患者未测定餐后浓度。在7例接受空腹和餐后检测的患者中，口服治疗期间空腹IAPP浓度为6.5±1.2 pmol l⁻¹（均值±标准误），早餐后90分钟升至13.5±3.1（p = 0.028）。胰岛素治疗期间，糖化血红蛋白（HbA1c）从8.6±0.5%降至7.5±0.4%（p<0.03），血浆C肽浓度显著降低（p<0.01）。在此期间，IAPP浓度变化百分比与C肽浓度变化百分比之间通过简单回归分析显示出密切相关性（r = 0.88；p<0.01）。在全部12例患者的资料中，利用所有48次可用测量值进行简单回归分析，IAPP浓度变化百分比与C肽浓度变化百分比之间存在显著相关性（r = 0.58：p<0.001）。这些数据表明，在NIDDM患者中，外源性胰岛素给药降低内源性胰岛素分泌时，IAPP的分泌也会降低。因此，如果IAPP分泌在NIDDM患者β细胞功能衰竭的发生中具有致病作用，胰岛素治疗可能会延缓这种恶化。
