In praise of the hyperglycemic clamp - A method for assessment of beta-cell sensitivity and insulin resistance
In praise of the hyperglycemic clamp - A method for assessment of beta-cell sensitivity and insulin resistance
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DOI：
10.2337/diacare.19.3.278
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发表时间：
1996-03-01
期刊：
影响因子：
16.2
通讯作者：
Elahl, D
中科院分区：
文献类型：
--
作者：
Elahl, D
用于评估β细胞反应和外周组织对胰岛素敏感性的最广泛使用的方法包括口服葡萄糖耐量试验（OGTT）、频繁采样的静脉内葡萄糖耐量试验和高胰岛素-正葡萄糖钳夹技术。在OGTT期间，葡萄糖水平在可变的滞后期后增加，然后达到峰值并在个体之间逐渐下降。在重复测试时，同一受试者的反应甚至不同。静脉内葡萄糖耐量试验可获得重现性更好的葡萄糖曲线，其中血浆葡萄糖水平迅速上升至非常高的水平，然后呈指数下降。这两种方法都没有达到稳态葡萄糖水平。在高胰岛素-正葡萄糖钳夹技术中，稳态葡萄糖水平可以在任何水平的高胰岛素血症下维持。然而，未获得β细胞敏感性的评估。较少使用的高血糖钳夹技术可以评估β细胞敏感性以及外周组织敏感性。此外，还可以确定葡萄糖有效性或非胰岛素介导的葡萄糖摄取的量度。通过该技术，所有受试者的β细胞都用相同的动脉葡萄糖浓度刺激，从而能够评估β细胞对相同血浆葡萄糖水平的反应。在葡萄糖耐受和不耐受状态下，通过单独或组合添加各种物质，可以比较对稳定的高血糖刺激的反应。使用高血糖钳和它的几个变种形式审查作为一种替代方法评估葡萄糖稳态。
The most widely used methods for the assessment of beta-cell response and peripheral tissue sensitivity to insulin include the oral glucose tolerance test (OGTT), the frequently sampled intravenous glucose tolerance lest, and the hyperinsulinemic-euglycemic clamp technique. During an OGTT, glucose levels increase after a variable lag period, then reach a peak and fall variably among individuals. The response even varies in the same subject upon repeat testing. A more reproducible glucose curve is achieved with an intravenous glucose tolerance test in which the plasma glucose levels rise rapidly to a very high level and fall exponentially. In neither of the two methods is a steady-state glucose level achieved. In the hyperinsulinemic-euglycemic clamp technique, a steady-state glucose level can be maintained al any level of hyperinsulinemia. However, an assessment of beta-cell sensitivity is not obtained. The less used hyperglycemic clamp technique can assess beta-cell sensitivity as well as peripheral tissue sensitivity. Moreover, a measure of glucose effectiveness or non-insulin-mediated glucose uptake can also be determined. With this technique the beta-cells of all subjects are stimulated with the same arterial glucose concentration, thus enabling assessment of beta-cell response to identical plasma glucose levels. Comparison of responses to stable hyperglycemic stimuli can be made in glucose-tolerant and -intolerant states with the addition of various substances, either alone or in combination. The use of the hyperglycemic clamp and several of its variant forms is reviewed as an alternative method for assessment of glucose homeostasis.