Could intranasal insulin be useful in the treatment of non-insulin-dependent diabetes mellitus?
Could intranasal insulin be useful in the treatment of non-insulin-dependent diabetes mellitus?
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鼻内胰岛素可用于治疗非胰岛素依赖型糖尿病吗？
DOI：
10.1016/0168-8227(91)90035-c
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发表时间：
1991
影响因子：
5.1
通讯作者：
Melby,JC
中科院分区：
文献类型：
--
作者：
Kimmerle,R;Griffing,G;McCall,A;Ruderman,NB;Stoltz,E;Melby,JC
为了评估鼻内胰岛素是否可以作为治疗NIDDM的膳食辅助，我们比较了11名NIDDM患者在鼻内胰岛素（INI）或安慰剂治疗后，混合早餐（9千卡/公斤，50%碳水化合物）的血糖和胰岛素反应。5例患者接受皮下胰岛素治疗，血糖控制良好至中度，6例患者口服胰岛素治疗失败，血糖控制不佳。在通常使用sc胰岛素的患者中，INI可抑制餐后高血糖。2例空腹血糖低的患者（≤7.8 mmol/l）比3例空腹血糖高的患者（10.5±0.5 mmol/l）需要更低的剂量（1 U/kg vs 1.5 U/kg体重）来实现这一目标。在有明显空腹高血糖（14.8±0.8 mmol/l）的口服药物患者中，当餐前给予INI （1 U/kg）和po格列本脲（10 mg）时，餐后高血糖仅短暂降低（90至120分钟）。先前接受sc胰岛素治疗的组在服用安慰剂后，餐后75分钟血浆游离胰岛素水平最大增加了23 mU/l。口服药物组有一个类似的但较晚的峰值增量（在180分钟），表明内源性胰岛素分泌在高血糖反应中更大的损害。INI后，所有患者血浆胰岛素的峰值增加出现得更早（餐后30分钟），并且在所有患者中都更大(先前胰岛素治疗组（剂量为1.0和1.5 U/kg）分别为55±18、139±68、86±24 mU/l，口服药物组（剂量为1.0 U/kg）。综上所述，鼻内胰岛素可以通过增加早期餐后胰岛素水平来降低NIDDM患者的餐后高血糖。它对空腹高血糖不太严重的人更有效。由于胰岛素水平升高和降血糖效果是短暂的，因此需要将鼻用胰岛素添加到通过饮食、口服药物或长效皮下胰岛素实现空腹血糖控制的方案中。
To evaluate whether intranasal insulin might be useful as a meal-adjunct in the treatment of NIDDM we compared plasma glucose and insulin responses to a mixed breakfast (9 kcal/kg, 50% carbohydrate) following either intranasal insulin (INI) or placebo in eleven patients with NIDDM. Five patients treated with subcutaneous insulin and in good to moderate glycemic control and six patients who were ‘failing’ on oral agents and in poor glycemic control were studied. In the patients usually on sc insulin, INI inhibited postprandial hyperglycemia. Lower doses (1 U/kg vs 1.5 U/kg b.w.) were needed to accomplish this in 2 patients with low fasting glucose (≤7.8 mmol/l) than in three patients with higher fasting glucose (10.5 ± 0.5 mmol/l). In the patients on oral agents who had marked fasting hyperglycemia (14.8 ± 0.8 mmol/l) an only transient reduction (for 90 to 120 min) of postprandial hyperglycemia was achieved when INI (1 U/kg) was given in addition to po glyburide (10 mg) prior to the meal. Following placebo in the group previously treated with sc insulin, plasma free insulin levels increased maximally by 23 mU/l, 75 min after the meal. The group on oral agents had a comparable but later peak increment (at 180 min) indicative of an even greater impairment of endogenous insulin secretion in response to hyperglycemia. Following INI, the peak increment in plasma insulin occurred earlier (30 min after the meal) and was greater in all patients (55 ± 18, 139 ± 68, 86 ± 24 mU/l respectively for the prior sc insulin therapy group at doses of 1.0 and 1.5 U/kg and for the oral agent group at 1.0 U/kg). In summary, intranasal insulin can reduce postprandial hyperglycemia in patients with NIDDM by increasing early postprandial insulin levels. It is more effective in those with less severe fasting hyperglycemia. Since elevated insulin levels and glucose lowering effect are transient, nasal insulin would need to be added to a regimen achieving fasting glucose control through diet, oral agents or long-acting subcutaneous insulin.