RECIPROCAL VARIATIONS IN INSULIN-STIMULATED GLUCOSE-UPTAKE AND PANCREATIC INSULIN-SECRETION IN WOMEN WITH NORMAL GLUCOSE-TOLERANCE
RECIPROCAL VARIATIONS IN INSULIN-STIMULATED GLUCOSE-UPTAKE AND PANCREATIC INSULIN-SECRETION IN WOMEN WITH NORMAL GLUCOSE-TOLERANCE
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DOI：
10.1016/1071-5576(95)00023-8
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发表时间：
1995-09-01
期刊：
影响因子：
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通讯作者：
DEFRONZO, RA
中科院分区：
文献类型：
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作者：
DIAMOND, MP;THORNTON, K;DEFRONZO, RA
目的：在胰岛素敏感性范围较大的受试者中维持正常的糖耐量。因此，人体必须拥有一种传感器机制，来评估身体对胰岛素的敏感性，并适当地调节胰岛素的分泌，以维持正常的葡萄糖稳态。方法：正常血糖高胰岛素钳夹(1mU/kg)。对32名椭圆形糖耐量试验正常的非肥胖女性进行了高血糖钳夹(+125 mg/dL)和高血糖钳夹(+125 mg/dL)研究。根据受试者在正糖胰岛素钳夹期间胰岛素介导的葡萄糖摄取率，将受试者分为四分位数。结果：全身葡萄糖摄取量变化三倍，范围从4.00到11.18 mg/kg。等一下。在高血糖钳夹期间，全身胰岛素介导的葡萄糖处置速率(胰岛素钳夹)与血浆总胰岛素反应之间存在显著的负相关(r=-0.50，P<；0.01)。胰岛素敏感性最低四分位数的女性(平均葡萄糖摄入量为5.07+/-0.20 mg/kg。在高血糖钳夹下(109+/-20mU/m L)，胰岛素反应最高。相比之下，胰岛素敏感度最高的四分位数(葡萄糖摄入量9.90+/-0.38 mg/kg)的女性。在低血糖钳夹状态下(55+/-16mU/mL；P<；001vs.最低四分位数)，胰岛素反应最低。结论：这些结果表明，在正常糖耐量受试者中，胰岛素介导的葡萄糖摄取和胰岛素分泌都存在很大的差异。尽管如此，正常的糖耐量是因为一种微调的平衡，它将胰岛β细胞对胰岛素分泌的需求与全身胰岛素敏感性水平联系在一起。
OBJECTIVE: Maintenance of normal glucose tolerance is achieved in subjects with a wide range of insulin sensitivity. It follows, therefore, that the body must possess a sensor mechanism that assesses the body's sensitivity to insulin and appropriately adjusts the secretion of insulin to maintain normal glucose homeostasis. We evaluated the relation between insulin action and insulin secretion.METHODS: Euglycemic hyperinsulinemic clamp (1 mU/kg . minute) and hyperglycemic clamp (+125 mg/dL) studies were performed in 32 non-obese women with normal oval glucose tolerance tests. The subjects were stratified into quartiles based upon their insulin-mediated rate of glucose uptake during the euglycemic insulin clamp.RESULTS: Total body glucose disposal varied threefold, ranging from 4.00 to 11.18 mg/kg . minute. A significant inverse relation (r = -0.50, P < .01) was noted between the rate of total body insulin-mediated glucose disposal (insulin clamp) and the total plasma insulin response during the hyperglycemic clamp. Women in the lowest quartile of insulin sensitivity (mean glucose uptake 5.07 +/- 0.20 mg/kg . minute) had the highest plasma insulin response during the hyperglycemic clamp (109 +/- 20 mu U/mL). In contrast, women in the highest quartile of insulin sensitivity (glucose uptake 9.90 +/- 0.38 mg/kg . minute) had the lowest plasma insulin response during the hypoglycemic clamp (55 +/- 16 mu U/mL; P < .001 versus the lowest quartile).CONCLUSIONS: These results demonstrate that among subjects with normal glucose tolerance, there exists a large variation in both insulin-mediated glucose uptake and pancreatic insulin secretion. Nonetheless, normal glucose tolerance is maintained because of a finely regulated balance, which couples the demand for insulin secretion by the pancreatic beta cells to the level of whole-body insulin sensitivity.