Small Doses of Subcutaneous Insulin as a Strategy for Preventing Slowly Progressive β-Cell Failure in Islet Cell Antibody—Positive Patients With Clinical Features of NIDDM
Small Doses of Subcutaneous Insulin as a Strategy for Preventing Slowly Progressive β-Cell Failure in Islet Cell Antibody—Positive Patients With Clinical Features of NIDDM
复制标题
小剂量皮下注射胰岛素作为预防胰岛细胞抗体缓慢进行性 β 细胞衰竭的策略——具有 NIDDM 临床特征的阳性患者
作者：
Tetsuro Kobayashi;K. Nakanishi;T. Murase;K. Kosáka
我们报告了一项初步研究，以确定皮下注射小剂量胰岛素对患有明显 NIDDM 的胰岛细胞抗体 (ICA) 阳性患者缓慢进展的 β 细胞损伤的预防作用。 10 名 ICA+ 的 NIDDM 患者被分为两组，每组 5 人。在胰岛素组（年龄：51±8岁[平均值±SD]，性别：3名男性和2名女性）中，中间型胰岛素（3-16 U/天）每天皮下注射一次或两次。磺酰脲类 (SU) 组（年龄：48 ± 11 岁，性别：3 名男性和 2 名女性）最初接受 SU 药物治疗。两组的 β 细胞功能变化（如 100 g 口服葡萄糖耐量试验期间的血清 C 肽反应和血糖值以及 ICA 和 GAD 抗体状态所示）的变化进行了长达 30 个月的评估。胰岛素组中，五名患者中有四名 ICA 状态转为阴性。 SU 组中任何患者的 ICA 状态均未变为阴性（与胰岛素组相比，P = 0.047）。两名患者的 ICA 状态持续呈阳性，其 β 细胞功能最终发展为胰岛素依赖状态，而其余三名患者的 ICA 状态则出现波动。在胰岛素组中，四名最初 GAD 抗体呈阳性的 NIDDM 患者中有 1 名患者的 GAD 抗体状态变为阴性。在 SU 组中，三名 NIDDM 患者的 GAD 抗体状态持续呈阳性（NS 组与胰岛素组）。胰岛素组的血清 C 肽反应在 6 个月和 12 个月内显着改善，而 SU 组则逐渐下降。 6、12、24 和 30 个月时，两组 C 肽反应的变化存在显着差异。胰岛素组的两小时血糖和 HbA1 值没有变化，但 SU 组却有所增加。皮下注射小剂量胰岛素可提高 ICA 转阴率并改善血清 C 肽反应，可能有效治疗具有缓慢进行性 β 细胞衰竭高风险的 ICA+ NIDDM 患者。
We report a pilot study to determine the preventive effect of small doses of insulin injected subcutaneously on slowly progressive β-cell damage in islet cell antibody (ICA)-positive patients with apparent NIDDM. Ten NIDDM patients who were ICA+ were divided into two groups of five. In the insulin group (age: 51 ± 8 years [mean ± SD], sex: 3 men and 2 women), intermediate-type insulin (3–16 U/day) was given once or twice daily as a subcutaneous injection. The sulfonylurea (SU) group (age: 48 ± 11 years, sex: 3 men and 2 women) was initially treated with a SU agent. Changes in β-cell function, as indicated by serum C-peptide responses and blood glucose values during a 100-g oral glucose tolerance test, as well as ICA and GAD antibody status, were evaluated for up to 30 months in both groups. ICA status became negative in four of five patients in the insulin group. ICA status did not become negative in any of the patients in the SU group (P = 0.047 vs. insulin group). ICA status was persistently positive in two patients whose β-cell function eventually progressed to an insulin-dependent state and fluctuated in the remaining three patients. In the insulin group, GAD antibody status became negative in one of four initially GAD antibody–positive NIDDM patients. In the SU group, GAD antibody status was persistently positive in three NIDDM patients (NS vs. insulin group). The serum C-peptide response improved significantly within 6 and 12 months in the insulin group, whereas it decreased progressively in the SU group. The changes in C-peptide response were significantly different between the two groups at 6, 12, 24, and 30 months. Two-hour blood glucose and HbA1 values were unchanged in the insulin group, but they increased in the SU group. Subcutaneous small doses of insulin, resulting in a high rate of negative conversion of ICA and an improved serum C-peptide response, may be effective in treating ICA+ NIDDM patients who are at high risk for slowly progressive β-cell failure.