Factors associated with improvement of fasting plasma glucose level by mealtime dosing of a rapid-acting insulin analog in type 2 diabetes
Factors associated with improvement of fasting plasma glucose level by mealtime dosing of a rapid-acting insulin analog in type 2 diabetes
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DOI：
10.1016/j.diabres.2006.07.019
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发表时间：
2007-03-01
影响因子：
5.1
通讯作者：
Kaneko, Shuichi
中科院分区：
文献类型：
--
作者：
Takamura, Toshinari;Sakurai, Masaru;Kaneko, Shuichi
本研究旨在探讨餐时给予速效胰岛素类似物严格控制血糖水平是否能改善2型糖尿病患者清晨空腹血糖（FPG）水平。大约一半（52.5%）的患者在餐时单独使用速效胰岛素类似物时达到了可达到的最低清晨FPG水平（最低FPG）< 120 mg/dL;这些患者不需要基础胰岛素替代。FPG最低值与糖尿病病程、基线体重指数（BMI）或血糖控制无关。所有接受磺脲类药物治疗的患者都需要基础胰岛素替代治疗。胰岛素对胰高血糖素和精氨酸的低反应，以及胰高血糖素对精氨酸的高反应可以解释餐后胰岛素替代单独改善FPG水平的失败。总之，大约一半的2型糖尿病患者通过速效胰岛素类似物单药治疗实现了FPG的适当控制。2型糖尿病的基础胰岛素分泌缺陷可以通过胰岛素对胰高血糖素和精氨酸的反应以及胰高血糖素对精氨酸的反应来估计。这项研究有助于更好地了解2型糖尿病胰岛素分泌特征异质性的病理生理学。(c)2006年由Elsevier爱尔兰有限公司出版。
This study investigated whether strict control of plasma glucose levels with mealtime dosing of a rapid-acting insulin analog improves early morning fasting plasma glucose (FPG) levels in patients with type 2 diabetes.A rapid-acting insulin analog was administered at each mealtime to 40 Japanese patients with type 2 diabetes whose existing antidiabetic medication was discontinued. Approximately one-half (52.5%) of the patients achieved a minimum early morning FPG levels achievable (nadir FPG) of < 120 mg/dL with mealtime dosing of a rapid-acting insulin analog alone; no basal insulin replacement was needed in these patients. Nadir FPG levels were independent of duration of diabetes, baseline body mass index (BMI) or glycemic control. All patients who had been treated with sulfonylureas needed basal insulin replacement. Low responses of insulin to glucagon and to arginine, and high response of glucagon to arginine may explain the failure to improve FPG levels with postprandial insulin replacement alone.In conclusion, approximately one-half of the patients with type 2 diabetes achieved appropriate control of FPG by rapid-acting insulin analog monotherapy. Basal insulin secretory defects in type 2 diabetes may be estimated by the responses of insulin to glucagon and to arginine and the response of glucagon to arginine. This study contributes to a better understanding of the pathophysiology contributing to the heterogeneity in the characteristics of insulin secretion in type 2 diabetes. (c) 2006 Published by Elsevier Ireland Ltd.