Prando R, Giusti R, Ciuchi E, Giusto M, Melga P L, Cheli V
Dipartimento di Medicina Interna, Cattedra di Malattie del Metabolismo, Università di Genova, Italy.
Riv Eur Sci Med Farmacol. 1996 May-Jun;18(3):95-104.
The secondary drug failure is a well known phenomenon in the development of type 2 diabetes mellitus, but an exact definition of this situation is still lacking. The aim of this research was to evaluate the beta-cell reserve in non obese diabetic patients in relation to the metabolic control and the duration of disease. The main aim was to identify values of postprandial plasma C-peptide that can characterize the patients requiring insulin treatment. A daily profile was performed in 135 non obese diabetic patients, within 20% of their ideal body weight. The mean diurnal values (m) and the mean post-prandial increases (delta mpp) of plasma glucose (G), insulin (IRI) and C-peptide (CP) were assessed. Fourty-four patients showed good (NwD-GC: G-m = 138 +/- 3.2 mg/dl) and 91 poor metabolic control (NwD-SF: G-m = 210 +/- 4.8 mg/dl), according to the G-m lower or higher than 150 mg/dl. Beta-cell reserve (CP-delta mpp: 0.70 +/- 0.03 vs 1.39 +/- 0.04 ng/ml) and C-peptide/insulin molar ratio (CP/IRA-delta mpp: 2.36 +/- 0.06 vs 2.80 +/- 0.06) were significantly lower (p < 0.001) in NwD-SF than in NwD-GC. NwD-GC and NwD-SF were respectively divided into three subgroups, according to the duration of disease. A progressive reduction of CP-delta mpp and an increase in SF prevalence, from the first to the third decade of diabetes duration, was observed. In both NwD-Gc and NwD-SF the duration of disease inversely correlated with CP-delta mpp (NwD-GC: y = 1.59-0.019X, p < 0.001; NwD-SF: y = 1.01-0.023X, p < 0.001). The analysis of the two regression lines showed that patients with CP-delta values lower than 1.0 ng/ml require insulin treatment. In conclusion the duration of diabetes and the progressive reduction of beta-cell reserve represent the major pathogenetic factors in secondary failure.
在2型糖尿病的发展过程中，继发性药物失效是一种众所周知的现象，但对这种情况仍缺乏确切的定义。本研究的目的是评估非肥胖糖尿病患者的β细胞储备与代谢控制及病程之间的关系。主要目的是确定能够表征需要胰岛素治疗的患者的餐后血浆C肽值。对135名体重在理想体重的20%以内的非肥胖糖尿病患者进行了每日情况记录。评估了血浆葡萄糖（G）、胰岛素（IRI）和C肽（CP）的平均日间值（m）和餐后平均增加值（δmpp）。根据G-m低于或高于150mg/dl，44名患者代谢控制良好（NwD-GC：G-m = 138±3.2mg/dl），91名患者代谢控制较差（NwD-SF：G-m = 210±4.8mg/dl）。NwD-SF组的β细胞储备（CP-δmpp：0.70±0.03对1.39±0.04ng/ml）和C肽/胰岛素摩尔比（CP/IRA-δmpp：2.36±0.06对2.80±0.06）显著低于NwD-GC组（p < 0.001）。根据病程，NwD-GC和NwD-SF分别分为三个亚组。观察到从糖尿病病程的第一个十年到第三个十年，CP-δmpp逐渐降低，SF患病率增加。在NwD-Gc和NwD-SF组中，病程均与CP-δmpp呈负相关（NwD-GC：y = 1.59 - 0.019X，p < 0.001；NwD-SF：y = 1.01 - 0.023X，p < 0.001）。对两条回归线的分析表明，CP-δ值低于1.0ng/ml的患者需要胰岛素治疗。总之，糖尿病病程和β细胞储备的逐渐减少是继发性失效的主要致病因素。
