Comparison of metabolic deterioration between insulin analog and regular insulin after a 5-hour interruption of a continuous subcutaneous insulin infusion in type 1 diabetic patients
Comparison of metabolic deterioration between insulin analog and regular insulin after a 5-hour interruption of a continuous subcutaneous insulin infusion in type 1 diabetic patients
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DOI：
10.1210/jc.84.8.2673
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发表时间：
1999-08-01
影响因子：
5.8
通讯作者：
Drouin, P
中科院分区：
文献类型：
--
作者：
Guerci, B;Meyer, L;Drouin, P
由于赖脯胰岛素类似物的药代动力学特征，中断连续皮下胰岛素输注 (CSII) 会导致 1 型糖尿病患者的代谢恶化更快。我们分析了 10 名 1 型糖尿病患者在 CSII 中断 5 小时和重新启动泵后 5 小时内发生的代谢变化。该研究是一项随机、交叉、开放标签设计，比较胰岛素类似物 [Lispro (LP)] 和常规胰岛素 [Velosuline (VE)]。从 0700 小时（零时间）到 1700 小时（600 分钟）每小时测量一次血浆葡萄糖、游离胰岛素、胰高血糖素、β-羟基丁酸 (β-OHB) 和非酯化脂肪酸 (NEFA)。停止CSII后，LP组血浆葡萄糖水平显着高于VE组（P < 0.05-0.01）。两种治疗后血浆游离胰岛素水平显着降低，但 LP 组显着低于 VE 组（P < 0.05-0.01）。 LP组血浆NEFA增加较快，且显着高于VE组（P < 0.01-0.05）。 LP 时血浆 β-OHB 较早增加，但治疗之间没有统计学差异。重新启动泵后，血浆葡萄糖随着LP的增加而下降，但随着VE的增加而继续增加，并且LP的血浆游离胰岛素峰值比VE的出现更早且更大（P < 0.05）。两种治疗后血浆 NEFA 和 β-OHB 水平显着下降，但 LP 治疗的下降幅度更大。因此，CSII 中赖脯胰岛素的短暂中断与更早、更大的代谢恶化有关，但赖脯胰岛素更有效地纠正了这种代谢恶化。
An interruption of continuous sc insulin infusion (CSII) of the insulin analog lispro should result in a more rapid metabolic deterioration of type 1 diabetic patients because of its pharmacokinetic characteristics. We analyzed the metabolic changes occurring during a 5-h interruption of CSII and the 5 h after restarting the pump in 10 type 1 diabetic patients. The study was a randomized, cross-over, open label design comparing insulin analog [Lispro (LP)] and regular insulin [Velosuline (VE)]. Plasma glucose, free insulin, glucagon, beta-hydroxybutyrate (beta-OHB), and nonesterified fatty acids (NEFA) were measured every hour from 0700 h (time zero) to 1700 h (600 min). After stopping CSII, the plasma glucose level was significantly higher in the LP group than in the VE group (P < 0.05-0.01). The plasma free insulin level decreased significantly with the two treatments, but was significantly lower with LP than with VE (P < 0.05-0.01). Plasma NEFA increased more rapidly and was significantly higher in the LP group than in the VE group (P < 0.01-0.05). Plasma beta-OHB increased earlier with LP, but was not statistically different between the treatments. After restarting the pump, plasma glucose decreased with LP, but continued to increase with VE, and the plasma free insulin peak occurred earlier and was greater with LP than with VE (P < 0.05). Plasma NEFA and beta-OHB levels decreased significantly with the two treatments, but more dramatically with LP treatment. Thus, a short interruption of Lispro in CSII is associated with an earlier, greater metabolic deterioration, but Lispro corrected this metabolic deterioration more effectively.