Patients with type 1 diabetes exhibit altered cerebral metabolism during hypoglycemia
Patients with type 1 diabetes exhibit altered cerebral metabolism during hypoglycemia
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DOI：
10.1172/jci62742
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发表时间：
2013-02-01
影响因子：
15.9
通讯作者：
de Galan, Bastiaan E.
中科院分区：
文献类型：
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作者：
de Ven, Kim C. C. van;Tack, Cees J.;de Galan, Bastiaan E.
1型糖尿病（T1DM）患者平均每周发生2 - 3次低血糖发作。本研究探讨低血糖对非合并症T1DM患者脑糖代谢的影响。为此，分别进行高胰岛素正糖钳和低血糖钳，使用[1-C-13]葡萄糖输注来增加血浆C-13的富集。采用体内脑C-13磁共振波谱法测量C-13标签进入不同代谢物的时间过程，并采用单室代谢模型计算三羧酸循环通量（V-TCA）。我们发现，由V-TCA反映的脑糖代谢，在T1DM患者中，正常血糖和低血糖状态没有显著差异。然而，V-TCA与HbA（1C）呈负相关，并且在低血糖状态下，比先前调查的健康受试者组高出约45%。这些数据表明，与非糖尿病患者相比，T1DM患者的大脑能够更好地忍受中度低血糖。
Patients with type 1 diabetes mellitus (T1DM) experience, on average, 2 to 3 hypoglycemic episodes per week. This study investigated the effect of hypoglycemia on cerebral glucose metabolism in patients with uncomplicated T1DM. For this purpose, hyperinsulinemic euglycemic and hypoglycemic glucose clamps were performed on separate days, using [1-C-13]glucose infusion to increase plasma C-13 enrichment. In vivo brain C-13 magnetic resonance spectroscopy was used to measure the time course of C-13 label incorporation into different metabolites and to calculate the tricarboxylic acid cycle flux (V-TCA) by a one-compartment metabolic model. We found that cerebral glucose metabolism, as reflected by the V-TCA, was not significantly different comparing euglycemic and hypoglycemic conditions in patients with T1DM. However, the V-TCA was inversely related to the HbA(1C) and was, under hypoglycemic conditions, approximately 45% higher than that in a previously investigated group of healthy subjects. These data suggest that the brains of patients with T1DM are better able to endure moderate hypoglycemia than those of subjects without diabetes.