Sindelka G, Skrha J, Hilgertová J, Justová V
III. Interní klinika I, LF UK a VFN, Praha.
Cas Lek Cesk. 1997 Sep 10;136(17):530-2.
Insulin resistance is in addition to impaired beta-cell function decisive for the development of type 2 diabetes. It is also known that obesity creates conditions for the development of insulin resistance. The authors tried therefore to influence insulin sensitivity by short-term reducing diets in obese type 2 diabetics.
The group of patients comprised 12 obese type 2 diabetics, BMI: 40.3 +/- 8.9 kg/m2, age 50 +/- 8 years. The control group was formed by 12 healthy non-obese subjects. The following parameters of glucose tolerance were assessed: total glucose consumption to maintain euglycaemia (M) during an isoglycaemic hyperinsulinaemic clamp on a Biostator, index of tissue sensitivity to insulin (M/I), metabolic glucose clearance (MCRG), number of insulin receptors on erythrocytes (Ro) and the insulin affinity for receptors (Ko). A reducing diet, 600 kcal/day, was served for 7 days during hospitalization. The body weight of diabetics dropped by 3.2 +/- 1.5 kg, p < 0.001, there was a significant decline of the basal blood sugar level (G(o)) from 11.4 +/- 3.6 to 8.4 +/- 3.0 mmol/l, p < 0.01; 2 there was a significant reduction of the serum insulin level (Io) from 30 +/- 18 to 27 +/- 19 mU/l, p < 0.02, whereby glucose uptake M increased from 24.0 +/- 7.5 to 29.5 +/- 8.9 mumol/kg/min, p < 0.01 and at the same time the metabolic glucose clearance increased from 2.3 +/- 0.9 to 4.0 +/- 2.5 ml/kg/min, p < 0.01, while the index of tissue sensitivity to insulin M/I increased less significantly from 16.3 +/- 7.4 to 18.0 +/- 10.5 mumol/kg/min per mU x 100). There was a decline in the number of insulin receptors on erythrocytes from 245 +/- 66 to 192 +/- 61 pmol/l, p < 0.02, whereby their affinity improved: 12.8 +/- 3.9 as compared with 17.3 +/- 5.4 10(8) l/mol, p < 0.01 but the insulin bond remained unchanged.
A short-term reducing diet leads to improvement of the majority of investigated indicators which is manifested in particular by improved action of insulin, above all at a postreceptor level. Significant reduction of the number of insulin receptors was partly compensated by improved affinity, while the insulin bond did not change in a marked way.
胰岛素抵抗除了会损害β细胞功能外，对2型糖尿病的发展也起决定性作用。众所周知，肥胖为胰岛素抵抗的发展创造了条件。因此，作者试图通过短期节食来影响肥胖2型糖尿病患者的胰岛素敏感性。
该患者组由12名肥胖2型糖尿病患者组成，体重指数（BMI）为40.3±8.9kg/m²，年龄50±8岁。对照组由12名健康非肥胖受试者组成。评估了以下糖耐量参数：在生物人工肾等血糖高胰岛素钳夹期间维持正常血糖所需的总葡萄糖消耗量（M）、组织对胰岛素的敏感性指数（M/I）、代谢性葡萄糖清除率（MCRG）、红细胞上胰岛素受体数量（Ro）以及胰岛素对受体的亲和力（Ko）。住院期间提供了为期7天的600千卡/天的节食方案。糖尿病患者的体重下降了3.2±1.5kg，p<0.001，基础血糖水平（G(o)）从11.4±3.6显著降至8.4±3.0mmol/l，p<0.01；血清胰岛素水平（Io）从30±18显著降至27±19mU/l，p<0.02，由此葡萄糖摄取量M从24.0±7.5增加至29.5±8.9μmol/kg/min，p<0.01，同时代谢性葡萄糖清除率从2.3±0.9增加至4.0±2.5ml/kg/min，p<0.01，而组织对胰岛素的敏感性指数M/I从16.3±7.4增加至18.0±10.5μmol/kg/min每mU×100的增加幅度较小。红细胞上胰岛素受体数量从245±6６降至192±61pmol/l，p<0.02，但其亲和力有所改善：从17.3±5.4×10⁸l/mol降至12.8±3.9×10⁸l/mol，p<0.01，但胰岛素结合量保持不变。
短期节食可使大多数研究指标得到改善，尤其表现为胰岛素作用的改善，主要是在受体后水平。胰岛素受体数量的显著减少部分被亲和力的提高所补偿，但胰岛素结合量没有明显变化。
