β-cell function and the development of diabetes-related complications in the diabetes control and complications trial
β-cell function and the development of diabetes-related complications in the diabetes control and complications trial
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DOI：
10.2337/diacare.26.3.832
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发表时间：
2003-03-01
期刊：
影响因子：
16.2
通讯作者：
Thomas, W
中科院分区：
文献类型：
--
作者：
Steffes, MW;Sibley, S;Thomas, W
在 1 型糖尿病患者中，通过测量与胰岛中的胰岛素共同分泌的连接肽（C 肽），可以估计剩余的 β 细胞分泌的胰岛素。在这项回顾性分析中，为了区分 1 型糖尿病中残余 β 细胞活性的增量益处，在糖尿病控制和并发症试验 (DCCT) 中，刺激（摄入混合餐后 90 分钟）C 肽水平与糖尿病视网膜病变和肾病的测量以及严重低血糖事件相关。根据测定的分析灵敏度 (0.03 nmol/l) 和研究进入标准，DCCT 受试者被分为四组刺激的 C 肽反应：进入时小于或等于 0.03、0.04-0.20、0.21-0.50 nmol/l，以及进入时和至少 1 年后（持续 C 肽分泌）0.21-0.50 nmol/l。在强化和部分传统 DCCT 治疗组中，任何 C 肽分泌，尤其是在较高且持续的刺激 C 肽水平下，均与视网膜病变（在接下来 6 个月就诊时糖尿病视网膜病变早期治疗研究 [ETDRS] 量表上的单一三步变化和重复三步变化）和肾病（蛋白尿 >40 mg/24 小时一次并在下一次重复）的发生率降低相关。年度访问）。两个治疗组中不同 C 肽水平的严重低血糖也存在差异。在强化治疗队列中，前三组的严重低血糖患病率基本相同（与 65% 的参与者相似）；然而，那些混合膳食刺激的 C 肽水平至少在基线和 DCCT 中首次年度就诊时>0.20 nmol/l 的受试者的患病率降低了约 30%。因此，即使进入 DCCT 时的β细胞活性水平较低，也与视网膜病变和肾病发病率的降低相关。此外，持续的 C 肽（胰岛素）分泌对于避免低血糖也很重要。 （强化糖尿病治疗的主要并发症）。
In patients with type 1 diabetes, measurement of connecting peptide (C-peptide), cosecreted with insulin from the islets of Langerhans, permits estimation of remaining beta-cell secretion of insulin. In this retrospective analysis to distinguish the incremental benefits of residual beta-cell activity in type 1 diabetes, stimulated (90 min following ingestion of a mixed meal) C-peptide levels at entry in the Diabetes Control and Complications Trial (DCCT) were related to measures of diabetic retinopathy and nephropathy and to incidents of severe hypoglycemia. Based on the analytical sensitivity of the assay (0.03 nmol/l) and study entry criteria, the DCCT subjects were divided into four groups of stimulated C-peptide responses: less than or equal to0.03, 0.04-0.20, 0.21-0.50 nmol/l at entry, and 0.21-0.50 nmol/l at entry and at least 1 year later (sustained C-peptide secretion). Uniformly in the intensive and partially in the conventional DCCT treatment groups, any C-peptide secretion, but especially at higher and sustained levels of stimulated C-peptide, was associated with reduced incidences of retinopathy (both a single three-step change and a repeated three-step change on the Early Treatment of Diabetic Retinopathy Study [ETDRS] scale at the next 6 month visit) and nephropathy (both albuminuria >40 mg/24 h once and repeated at the next annual visit). There were also differences in severe hypoglycemia across C-peptide levels in both treatment groups. In the intensively treated cohort there were essentially identical prevalences of severe hypoglycemia (similar to65% of participants) in the first three groups; however, those subjects with mixed-meal stimulated C-peptide level >0.20 nmol/l for at least baseline and the first annual visit in the DCCT experienced a reduced prevalence of similar to30%. Therefore, even modest levels of beta-cell activity at entry in the DCCT were associated with reduced incidences of retinopathy and nephropathy. Also, continuing C-peptide (insulin) secretion is important in avoiding hypoglycemia. (the major complication of intensive diabetic therapy).