POSTPRANDIAL OSCILLATORY PATTERNS OF BLOOD-GLUCOSE AND INSULIN IN NIDDM - ABNORMAL DIURNAL INSULIN-SECRETION PATTERNS AND GLUCOSE-HOMEOSTASIS INDEPENDENT OF OBESITY
POSTPRANDIAL OSCILLATORY PATTERNS OF BLOOD-GLUCOSE AND INSULIN IN NIDDM - ABNORMAL DIURNAL INSULIN-SECRETION PATTERNS AND GLUCOSE-HOMEOSTASIS INDEPENDENT OF OBESITY
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DOI：
10.2337/diacare.12.10.709
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发表时间：
1989-11-01
期刊：
影响因子：
16.2
通讯作者：
ROBBINS, DC
中科院分区：
文献类型：
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作者：
CALLESESCANDON, J;JASPAN, J;ROBBINS, DC
与对照组相比，非胰岛素依赖型糖尿病（NIDDM）患者的血胰岛素和血糖浓度均存在定量和定性异常。本研究的目的是确定是否以及在何种程度上正常观察到的多相模式的胰岛素和葡萄糖反应的混合餐是精神错乱的NIDDM。共有24名志愿者在0745，1145和1645吃了三顿相同成分的饭。其中12人患有NIDDM，其余为年龄和体重匹配的健康非糖尿病对照组。从06：30至19：30，每10分钟采血一次，用于测量C肽、胰岛素和葡萄糖浓度。通过基于计算机的算法分析峰。糖尿病志愿者与对照组有几个不同之处。首先，尽管胰岛素峰的数量相似，但第一个餐后峰的出现持续延迟20-30分钟。第二，午餐后的胰岛素浓度高于早餐后，而对照组则相反。第三，早餐后的综合代谢率高于午餐后。第四，在午餐后的前30分钟内葡萄糖浓度降低，表明在一天中的这个时间加速葡萄糖处置和/或增强内源性葡萄糖产生的抑制。这些数据表明，胰岛素分泌和行动和葡萄糖稳态在NIDDM是更复杂的比通常理解。这种动态状态是无法检测到的，除非有来自胰岛素和葡萄糖测量的频繁血液采样。我们观察到的这些参数的定量和定性异常与肥胖无关，这表明需要扩大NIDDM的病理生理学定义。
Compared with control subjects, non-insulin-dependent diabetes mellitus (NIDDM) subjects had both quantitative and qualitative abnormalities in blood insulin and glucose concentrations. The purpose of this study was to determine whether and to what extent normally observed multiphasic patterns of insulin and glucose responses to mixed meals are deranged in NIDDM. A total of 24 volunteers were studied while eating three meals of identical composition at 0745, 1145, and 1645. Twelve had NIDDM, and the remainder were healthy nondiabetic age- and weight-matched control subjects. Blood was withdrawn every 10 min from 0630 to 1930 for measurement of C-peptide, insulin, and glucose concentrations. Peaks were analyzed by computer-based algorithms. Diabetic volunteers displayed several differences from control subjects. First, although the number of insulin peaks was similar, there was a consistent delay of 20-30 min in the appearance of the first postprandial peak. Second, insulin concentrations after lunch were higher than after breakfast, whereas the reverse pattern occurred in control subjects. Third, integrated glycemia was greater after breakfast than after lunch. Fourth, glucose concentrations decreased during the first 30 min after lunch, suggesting accelerated glucose disposal and/or enhanced suppression of endogenous glucose production at this time of day. These data demonstrate that insulin secretion and action and glucose homeostasis in NIDDM are more complex than commonly appreciated. This dynamic state is undetected unless there is frequent blood sampling from measurement of insulin and glucose. The quantitative and qualitative abnormalities that we observed in these parameters are independent of obesity and suggest the need to expand the pathophysiological definition of NIDDM.