RELATIONSHIP BETWEEN PLASMA-GLUCOSE AND INSULIN CONCENTRATION, GLUCOSE-PRODUCTION, AND GLUCOSE DISPOSAL IN NORMAL SUBJECTS AND PATIENTS WITH NON-INSULIN-DEPENDENT DIABETES
RELATIONSHIP BETWEEN PLASMA-GLUCOSE AND INSULIN CONCENTRATION, GLUCOSE-PRODUCTION, AND GLUCOSE DISPOSAL IN NORMAL SUBJECTS AND PATIENTS WITH NON-INSULIN-DEPENDENT DIABETES
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DOI：
10.1172/jci113572
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发表时间：
1988-07-01
影响因子：
15.9
通讯作者：
REAVEN, GM
中科院分区：
文献类型：
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作者：
CHEN, YDI;JENG, CY;REAVEN, GM
在14个人中记录了肝脏葡萄糖产生（Ra），组织葡萄糖处置（Rd），血浆葡萄糖和胰岛素浓度的变化，发生在16小时内从10至下午2点; 8与非胰岛素依赖型糖尿病（NIDDM）和6与正常葡萄糖耐量。NIDDM患者在晚上10点的Ra值高于正常值（4.73 +/- 0.41 vs. 3.51 +/- 0.36 mg/kg/min，P <0.001），但在整个晚上的下降速度比正常受试者快得多。结果，正常个体和NIDDM患者的Ra之间的差异逐渐缩小，到下午2点，已停止存在（1.75 +/- 0.61 vs 1.67 +/- 0.47 mg/kg/min，P = NS）。在同一时期，NIDDM患者的血糖浓度也有所下降，但他们仍然相当高血糖，下午2点的血糖值为245 +/- 27 mg/dl，约为正常人的3倍。血浆胰岛素浓度也从晚上10点到2点逐渐下降，并且在16小时研究期间的大部分时间内两组相似。因此，尽管伴随血糖和胰岛素浓度的福尔斯下降，但NIDDM患者的Ra仍进行性下降。两组的葡萄糖处理率也逐渐下降，但NIDDM患者的下降幅度更大。因此，NIDDM患者的Rd在晚上10点较高（3.97 +/- 0.48 vs. 3.25 +/- 0.13 mg/kg/min，P <0.001），第二天下午2点较低（1.64 +/- 0.21 vs. 1.97 +/- 0.35 mg/kg/min，P <0.01）。这些结果表明，当Ra值与在可比条件下研究的正常受试者的Ra值相同时，NIDDM患者中可以存在大大扩展的池大小，这表明NIDDM中的空腹高血糖不仅仅是Ra增加的函数。
The changes in hepatic glucose production (Ra), tissue glucose disposal (Rd), and plasma glucose and insulin concentration that took place over a 16-h period from 10 to 2 p.m. were documented in 14 individuals; 8 with non-insulin-dependent diabetes mellitus (NIDDM) and 6 with normal glucose tolerance. Values for Ra were higher than normal in patients with NIDDM at 10 p.m. (4.73 +/- 0.41 vs. 3.51 +/- 0.36 mg/kg per min, P less than 0.001), but fell at a much faster rate throughout the night than that seen in normal subjects. As a consequence, the difference between Ra in normal individuals and patients with NIDDM progressively narrowed, and by 2 p.m., had ceased to exist (1.75 +/- 0.61 vs. 1.67 +/- 0.47 mg/kg per min, P = NS). Plasma glucose concentration also declined in patients with NIDDM over the same period of time, but they remained quite hyperglycemic, and the value of 245 +/- 27 mg/dl at 2 p.m. was about three times greater than in normal individuals. Plasma insulin concentrations also fell progressively from 10 to 2 p.m., and were similar in both groups throughout most of the 16-h study period. Thus, the progressive decline in Ra in patients with NIDDM occurred despite concomitant falls in both plasma glucose and insulin concentration. Glucose disposal rates also fell progressively in both groups, but the magnitude of the fall was greater in patients with NIDDM. Consequently, Rd in patients with NIDDM was higher at 10 p.m. (3.97 +/- 0.48 vs. 3.25 +/- 0.13 mg/kg per min, P less than 0.001) and lower the following day at 2 p.m. (1.64 +/- 0.21 vs. 1.97 +/- 0.35 mg/kg per min, P less than 0.01). These results indicate that a greatly expanded pool size can exist in patients with NIDDM at a time when values for Ra are identical to those in normal subjects studied under comparable conditions, which suggests that fasting hyperglycemia in NIDDM is not simply a function of an increase in Ra.