Effects of tolazamide and exogenous insulin on insulin action in patients with non-insulin-dependent diabetes mellitus.
Effects of tolazamide and exogenous insulin on insulin action in patients with non-insulin-dependent diabetes mellitus.
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妥拉磺酰胺和外源性胰岛素对非胰岛素依赖型糖尿病患者胰岛素作用的影响。
DOI：
10.1056/nejm198605153142003
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发表时间：
1986
期刊：
影响因子：
--
通讯作者：
Rizza,RA
中科院分区：
文献类型：
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作者：
Firth,RG;Bell,PM;Rizza,RA
为了确定磺脲类药物和外源性胰岛素是否对胰岛素作用有不同的影响，我们采用随机交叉设计，对8例非胰岛素依赖型糖尿病患者在服用托拉扎胺和外源性半合成人胰岛素治疗3个月前后进行了研究。服用托拉扎胺的患者和接受胰岛素治疗的患者在血糖控制方面有相似的改善，如平均糖化血红蛋白(±SEM)从9.4±0.7%下降到7.7±0.5%，外源性胰岛素从9.4±0.7%下降到7.1±0.2%(两组比较P<；0.01)。接受托拉扎胺或外源性胰岛素治疗后，吸收后产糖率(分别从2.3±0.1降至2.0±0.2毫克/分钟和1.8±0.1毫克/分钟)降低相似(P<；0.05)，但不能降至正常(1.5±0.1毫克/分钟)。在超生理胰岛素浓度(从6.2±0.7毫克/分钟至7.7±0.6毫克/分钟，外源性胰岛素为7.8±0.6毫克/分钟)至非糖尿病患者(7.9±0.5毫克/分钟)时，托拉扎胺和外源性胰岛素均可增加(P<；0.05)葡萄糖利用率。这两种药物都没有改变生理胰岛素浓度下的红细胞胰岛素结合力。我们得出结论，在非胰岛素依赖型糖尿病患者中，使用磺脲类药物或外源性胰岛素治疗可以同样改善胰岛素的作用。因此，在这些药物之间的选择应该基于它们改善胰岛素抵抗的能力以外的考虑。(《英国医学杂志》1986；314：1280-6)
To determine whether sulfonylureas and exogenous insulin have different effects on insulin action, we studied eight patients with non-insulin-dependent diabetes mellitus before and after three months of treatment with tolazamide and exogenous semisynthetic human insulin, using a randomized crossover design. Therapy with tolazamide and therapy with insulin resulted in similar improvement of glycemic control, as measured by a decrease in mean glycosylated hemoglobin (±SEM) from 9.4±0.7 percent to 7.7±0.5 percent with tolazamide and to 7.1±0.2 percent with exogenous insulin (P<0.01 for both comparisons). Therapy with either tolazamide or exogenous insulin resulted in a similar lowering (P<0.05) of postabsorptive glucose-production rates (from 2.3±0.1 to 2.0±0.2 and 1.8±0.1 mg per kilogram of body weight per minute, respectively) but not to normal (1.5±0.1 mg per kilogram per minute). Both tolazamide and exogenous insulin increased (P<0.05) glucose utilization at supraphysiologic insulin concentrations (from 6.2±0.7 to 7.7±0.6 mg per kilogram per minute with tolazamide and to 7.8±0.6 mg per kilogram per minute with exogenous insulin) to nondiabetic rates (7.9±0.5 mg per kilogram per minute). Neither agent altered erythrocyte insulin binding at physiologic insulin concentrations.We conclude that treatment with sulfonylureas or exogenous insulin results in equivalent improvement in insulin action in patients with non-insulin-dependent diabetes mellitus. Therefore, the choice between these agents should be based on considerations other than their ability to ameliorate insulin resistance. (N Engl J Med 1986; 314:1280–6.)