IMPAIRED INSULIN ACTION IN PUBERTY - A CONTRIBUTING FACTOR TO POOR GLYCEMIC CONTROL IN ADOLESCENTS WITH DIABETES
IMPAIRED INSULIN ACTION IN PUBERTY - A CONTRIBUTING FACTOR TO POOR GLYCEMIC CONTROL IN ADOLESCENTS WITH DIABETES
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DOI：
10.1056/nejm198607243150402
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发表时间：
1986-07-24
影响因子：
158.5
通讯作者：
TAMBORLANE, WV
中科院分区：
文献类型：
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作者：
AMIEL, SA;SHERWIN, RS;TAMBORLANE, WV
胰岛素依赖型糖尿病患者通常在青春期代谢控制不良。为了确定青春期是否与胰岛素刺激的葡萄糖代谢降低有关，我们比较了成人和青春期前和青春期儿童伴和不伴胰岛素依赖型糖尿病的正常血糖胰岛素钳夹研究结果。在非糖尿病青春期儿童中，胰岛素刺激的葡萄糖代谢（201 . ±. 12毫克/平方米体表面积/分钟），与青春期前儿童和成人（316 . ±. 34和290 .+-. 21 mg/m2; P < 0.01），尽管具有相当的高胰岛素血症（胰岛素水平为80至90 μ U/ml）。同样，青春期糖尿病儿童对胰岛素的反应比青春期前糖尿病儿童（P < 0.05）和成人（P = 0.07）低25%至30%。在各发育阶段，糖尿病儿童胰岛素对糖代谢的刺激作用降低33%~ 42%（P < 0.01）。在所有研究的儿童组中，胰岛素的反应与24小时生长激素的平均水平呈负相关（r =-0.52，P = 0.01）。在糖尿病儿童中，青春期儿童的糖化血红蛋白水平显著高于青春期前儿童（P < 0.02），尽管每日胰岛素剂量倾向于更高。这些数据表明，胰岛素抵抗发生在青春期在正常儿童和糖尿病儿童。青春期和糖尿病对胰岛素作用的联合不良影响可能有助于解释为什么在青少年患者中很难控制血糖。
Patients with insulin-dependent diabetes mellitus often have poor metabolic control during puberty. To determine whether puberty is associated with decreased insulin-stimulated glucose metabolism, we compared the results of euglycemic insulin-clamp studies in adult and prepubertal and pubertal children with and without insulin-dependent diabetes. In nondiabetic pubertal children, insulin-stimulated glucose metabolism (201 .+-. 12 mg per square meter of body surface area per minute) was sharply reduced, as compared with that of prepubertal children and adults (316 .+-. 34 and 290 .+-. 21 mg per square meter, respectively; P < 0.01), despite comparable hyperinsulinemia (insulin levels of 80 to 90 .mu.U per milliliter). Similarly, the response to insulin was 25 to 30 percent lower in the diabetic pubertal children than in the diabetic prepubertal children (P < 0.05) and adults (P = 0.07). At each stage of development, the stimulating effect of insulin on glucose metabolism was decreased by 33 to 42 percent in the children with diabetes (P < 0.01). In all the groups of children studied, the reposnse to insulin was inversely correlated with mean 24-hour levels of growth hormone (r = - 0.52, P = 0.01). Among the diabetic children, the glycosylated hemoglobin levels were substantially higher in the pubertal children than in the prepubertal children (P < 0.02), although the daily insulin doses tended to be higher. These data suggest that insulin resistance occurs during puberty in both normal children and children with diabetes. The combined adverse effects of puberty and diabetes on insulin action may help explain why control of glycemia is so difficult to achieve in adolescent patients.