Chronic reduction of fasting glycemia with insulin glargine improves first- and second-phase insulin secretion in patients with type 2 diabetes.
Chronic reduction of fasting glycemia with insulin glargine improves first- and second-phase insulin secretion in patients with type 2 diabetes.
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DOI：
10.2337/dc11-0471
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发表时间：
2011-09
期刊：
影响因子：
16.2
通讯作者：
Meier JJ
中科院分区：
文献类型：
--
作者：
Pennartz C;Schenker N;Menge BA;Schmidt WE;Nauck MA;Meier JJ
2型糖尿病高血糖患者胰岛素分泌通常减少。我们研究了甘精胰岛素长期基础胰岛素治疗是否能改善葡萄糖诱导的胰岛素分泌。14例接受二甲双胍单药治疗的2型糖尿病患者接受了为期8周的甘精胰岛素添加治疗。在干预前后进行静脉葡萄糖耐量试验（IVGTT），使用3小时静脉胰岛素输注调整空腹血糖水平。空腹血糖从179.6 ± 7.5降至117.6 ± 6.5 mg/dL（P < 0.001），糖化血红蛋白从8.4 ± 0.5降至7.1 ± 0.2%（P = 0.0046）。最终胰岛素剂量为59.3 ± 10.2 IU。静脉注射胰岛素使空腹血糖急性正常化可降低IVGTT期间的C肽水平（P < 0.0001）。相比之下，甘精胰岛素治疗期后，胰岛素和C肽对静脉注射葡萄糖的反应显着更大（分别P < 0.0001）。甘精胰岛素治疗期后，第一时相和第二时相胰岛素分泌均显著增加（分别为P < 0.05）。在有和没有急性调整空腹血糖的实验中都观察到胰岛素分泌的这些改善。长期补充长效基础胰岛素可改善2型糖尿病高血糖患者的葡萄糖诱导胰岛素分泌，而急性外源性胰岛素给药可降低β细胞对葡萄糖给药的反应。这些数据为基础胰岛素治疗方案改善2型糖尿病高血糖患者的餐后内源性胰岛素分泌提供了依据。
Insulin secretion is often diminished in hyperglycemic patients with type 2 diabetes. We examined whether chronic basal insulin treatment with insulin glargine improves glucose-induced insulin secretion. Fourteen patients with type 2 diabetes on metformin monotherapy received an add-on therapy with insulin glargine over 8 weeks. Intravenous glucose tolerance tests (IVGTTs) were performed before and after the intervention, with and without previous adjustment of fasting glucose levels using a 3-h intravenous insulin infusion. Fasting glycemia was lowered from 179.6 ± 7.5 to 117.6 ± 6.5 mg/dL (P < 0.001), and HbA1c levels declined from 8.4 ± 0.5 to 7.1 ± 0.2% (P = 0.0046). The final insulin dose was 59.3 ± 10.2 IU. Acute normalization of fasting glycemia by intravenous insulin reduced C-peptide levels during the IVGTT (P < 0.0001). In contrast, insulin and C-peptide responses to intravenous glucose administration were significantly greater after the glargine treatment period (P < 0.0001, respectively). Both first- and second-phase insulin secretion increased significantly after the glargine treatment period (P < 0.05, respectively). These improvements in insulin secretion were observed during both the experiments with and without acute adjustment of fasting glycemia. Chronic supplementation of long-acting basal insulin improves glucose-induced insulin secretion in hyperglycemic patients with type 2 diabetes, whereas acute exogenous insulin administration reduces the β-cell response to glucose administration. These data provide a rationale for basal insulin treatment regiments to improve postprandial endogenous insulin secretion in hyperglycemic patients with type 2 diabetes.
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