Suppression of the nocturnal free fatty acid levels by bedtime cornstarch in NIDDM subjects

The aim of the present study was to examine the effects of a large dose of slow-release carbohydrates (CHOs) at bedtime on the nocturnal glucose, insulin and free fatty acid (FFA) levels, and to assess the putative effects on morning fasting and post-prandial glucose levels in patients with moderately controlled non-insulin-dependent diabetes mellitus (NIDDM). Unheated cornstarch (106 g of CHO) or a mixed equicaloric meal (58 g of CHO) was given at 22.00 hours to 10 NIDDM patients. For comparison, the patients were also given a smaller mixed meal at 22.00 hours on a third occasion (17 g of CHO). Compared with the mixed meals, cornstarch led to a slightly elevated early-morning plasma insulin level and a suppression of the nocturnal FFA level ( P  < 0.05), as well as to a reduced incremental glucose level (IAUC) after breakfast the next morning by approximately 30% ( P  < 0.05). There was a significant and linear relationship between the nocturnal FFA level and the glucose IAUC after breakfast ( r  = 0.44, P  < 0.02), indicating that the effect may have been mediated by the suppressive effect of cornstarch on nocturnal lipolysis. In summary, bedtime intake of unheated cornstarch in NIDDM subjects is associated with a suppression of the nocturnal FFA levels and a reduced glucose IAUC after breakfast. As the treatment did not improve overall glucose control, studies of the effects of an individually titrated amount of cornstarch are proposed to further explore the putative favourable effects of bedtime cornstarch in the treatment of NIDDM.     

Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study

Summary In primary care it is difficult to treat the growing number of non-insulin-dependent diabetic (NIDDM) patients according to (inter)national guidelines. A prospective, controlled cohort study was designed to assess the intermediate term (2 years) effect of structured NIDDM care in general practice with and without ’diabetes service' support on glycaemic control, cardiovascular risk factors, general well-being and treatment satisfaction. The ’diabetes service', supervised by a diabetologist, included a patient registration system, consultation facilities of a dietitian and diabetes nurse educator, and protocolized blood glucose lowering therapy advice which included home blood glucose monitoring and insulin therapy. In the study group (SG; 22 general practices), 350 known NIDDM patients over 40 years of age (206 women; mean age 65.3 ± SD 11.9; diabetes duration 5.9 ± 5.4 years) were followed for 2 years. The control group (CG; 6 general practices) consisted of 68 patients (28 women; age 64.6 ± 10.3; diabetes duration 6.3 ± 6.4 years). Mean HbA_{1 c} (reference 4.3–6.1 %) fell from 7.4 to 7.0 % in SG and rose from 7.4 to 7.6 % in CG during follow-up (p = 0.004). The percentage of patients with poor control (HbA_{1 c} > 8.5 %) shifted from 21.4 to 11.7 % in SG, but from 23.5 to 27.9 % in CG (p = 0.008). Good control (HbA_{1 c} < 7.0 %) was achieved in 54.3 % (SG; at entry 43.4 %) and 44.1 % (CG; at entry 54.4 %) (p = 0.013). Insulin therapy was started in 29.7 % (SG) and 8.8 % (CG) of the patients (p = 0.000) with low risk of severe hypoglycaemia (0.019/patient year). Mean levels of total and HDL-cholesterol (SG), triglycerides (SG) and diastolic blood pressure (SG + CG) and the percentage of smokers (SG) declined significantly, but the prevalence of these risk factors remained high. General well-being (SG) did not change during intensified therapy. Treatment satisfaction (SG) tended to improve. Implementation of structured care, including education and therapeutic advice, results in sustained good glycaemic control in the majority of NIDDM patients in primary care, with low risk of hypoglycaemia. Lowering cardiovascular risk requires more than reporting results and referral to guidelines. [Diabetologia (1997) 40: 1334–1340] Received: 5 February 1997 and in revised form: 22 May 1997     

豆番粉与玉米粉对人体血糖胰岛素胰升血糖素的影响

目的探讨豆番粉和玉米粉对人体餐后血糖、胰岛素、胰升血糖素的影响。方法选择Ⅱ型糖尿病人、肥胖人、健康人，ｄ１均进食面粉，ｄ２随机进食豆番粉或玉米粉，测量２ｄ的空腹血糖及餐后３０、６０、１２０、１８０ｍｉｎ各５个时点的血糖、胰岛素、胰升血糖素值。结果糖尿病人进食豆番粉后６０、１２０、１８０ｍｉｎ的血糖值低于进食面粉，Ｐ分别＜０．０１、０．０１、０．０５；进食玉米粉后１２０、１８０ｍｉｎ血糖值低于面粉，Ｐ＜０．０５。２种实验食物的血糖增值面积均低于面粉，Ｐ＜０．０５；进食豆番粉后各时点胰岛素值、胰升血糖素值明显低于进食面粉，Ｐ＜０．０５或＜０．０１；进食玉米粉后同时点胰岛素值与面粉相比无显著性差异，胰升糖素值３０、１２０ｍｉｎ有显著性差异。肥胖人进食豆番粉后血糖值与面粉相比无显著性差异，但胰岛素值、胰升血糖素值有明显下降，各时点值Ｐ均＜０．０５。结论①豆番粉血糖指数低，可控制餐后高血糖状态，不增加胰岛素、胰升血糖素分泌，可减轻胰岛素抵抗。②玉米粉血糖曲线增值面积、低于面粉，可作为糖尿病人选择的食品，对改善胰岛素抵抗也有较好的作用。     

cAMP对胰岛素刺激的NIH3T3细胞丝裂原激活蛋白激酶活性的抑制作用

目的 探讨cAMP-PKA信号途径对胰岛素激活的Ras-丝裂原激活蛋白激酶(MAPK)信号途径的影响。方法 以3-异丁基-1-甲基黄嘌呤(IBMX)提高细胞内环腺苷酸(cAMP)浓度，藉四唑蓝比色法(MTT法)和蛋白免疫印迹试验分别观察cAMP对胰岛素刺激的小鼠成纤维细胞(NIH3T3细胞)的生长增殖和胞内丝裂原激活蛋白激酶(MAPK)活性的影响。结果 IBMX(0．5mmol/L)抑制静息的和胰岛素(10mU／mL)刺激的NIH3T3细胞的增殖，作用呈时间依赖性。在胰岛素(10mU／mL)刺激的NIH3T3细胞，MAPK出现酪氨酸磷酸化；而以IBMX(0．5mmol/L)预处理细胞30min后，再以胰岛素作用10min，胰岛素刺激的MAPK的酪氨酸磷酸化受抑制。结论：cAMP可通过抑制MAPK磷酸化活化对NIH3T3细胞增殖起抑制作用。     

胰岛素泵治疗与2型糖尿病第一时相分泌的研究进展

随着对糖尿病机理研究的深入，发现胰岛β细胞第一时相分泌，对糖尿病的发生、发展有重要影响，新诊断2型糖尿病患者早期予胰岛素泵治疗，模拟生理性胰岛素分泌方式，可改善第一时相分泌，促进胰岛β细胞功能的修复，利于糖尿病的治疗及预后。     

早期营养对IUGR大鼠糖耐量和胰岛素敏感性的远期影响

【目的】了解宫内发育迟缓(IUGR)和生后早期蛋白质营养不良对IUGR大鼠糖耐量和胰岛素敏感指数(ISI)及胰岛素抵抗指数(IRI)的远期影响。【方法】采用被动吸烟法制作IUGR大鼠动物模型,新生正常鼠仔102只和IUGR鼠仔105只随机分为4组:①正常对照组;②IUGR模型组;③正常大鼠低蛋白饮食组(CLP组);④IUGR大鼠低蛋白饮食组(SLP组)。观察各组大鼠在生后4周(幼年期)、12周(成年期)和48周龄(老年期)时糖耐量和胰岛素释放试验变化。【结果】①SLP组大鼠宫内发育迟缓和生后早期蛋白质营养不良其远期葡萄糖-胰岛素代谢功能受损明显,至48周时空腹血糖(5.2±1.4)mmol/L已升高,胰岛素(31. 2±3.4)mU/L水平明显升高,ISI(1.7±0.4)明显下降,IRI(8.7±1.8)明显升高,与正常对照组[(4.5±1.1)mmol/L,(12.9±1.0)mU/L和2.8±0.2,2.3±0.41比较均有显著性差异(P<0.05或P<0.01)。②CLP组大鼠生后早期单纯蛋白质营养不良的远期影响主要表现为糖负荷后胰岛素对血糖升高的应答分泌反应延迟和糖耐量减低。③IUGR模型组大鼠生后即给予正常营养供给,其葡萄糖-胰岛素代谢紊乱的程度减轻,但仍有糖耐量减低。【结论】在宫内和/或生后早期机体发育的关键时期,蛋白质营养不良将对葡萄糖-胰岛素代谢功能产生长期的不良影响,主要表现为糖耐量减     

Synthesis of JTT‐501 and its metabolite JTP‐20604 labelled with 13C

JTT‐501 specifically labelled with ¹³C was obtained via a four‐step synthesis at an isotopic enrichment level of 99% and in 14% overall chemical yield starting from 4‐hydroxy‐[ring‐U‐¹³C₆]benzaldehyde (3) . The hydrogenation of [¹³C₆]JTT‐501 over Pd/C gave [¹³C₆]JTP‐20604 in 90% chemical yield. Copyright © 2003 John Wiley & Sons, Ltd.     

胰岛素抵抗与高血压病冠心病糖尿病的关系

目的探讨中老年人高血压、冠心病、糖尿病胰岛素抵抗的状况及相关因素。方法按中老年高血压病、冠心病、糖尿病、高血压合并冠心病等类别分组、并设对照组，计体重指数、测血脂、血糖、胰岛素及胰岛素抗体浓度，并根据血糖、血胰岛素浓度计算胰岛素敏感性．结果胰岛素抵抗在冠心病、高血压病、高血压合并冠心病及糖尿病中依次递增．设对照组胰岛素相对敏感性为１，则上述各病分别为０８３、０．７９、０６１、０．３２．与之相伴随的是糖及脂质代谢紊乱及体重指数的增加。结论高血压、冠心病、糖尿病多存在胰岛素抵抗，并可能是心血管疾病的危险因子。     

IGFBP-1检测在妊娠晚期气囊引产中的临床意义

【目的】比较宫颈Bishop评分和宫颈胰岛素样生长因子结合蛋白 1(IGFBP 1)检测在妊娠晚期气囊助产中的临床意义。【方法】将妊娠晚期有引产指征的 15 0例初产妇随机分成 3组 ,每组 5 0例。A组在气囊助产前使用宫颈IGFBP 1检测作为引产时机预测 ,B组在气囊助产前使用宫颈Bishop评分作为引产时机预测 ,C组则单纯催产素引产同时使用宫颈Bish op评分作为引产时机预测。【结果】总引产时间、潜伏期、活跃期、第一产程、第二产程 ,A、B两组较C组短 (P <0 0 1) ;A组总引产时间较B组短 (P <0 0 5 ) ;A组潜伏期、活跃期、第一产程、第二产程的较B组短 ,但差别无统计学意义 ;阴道分娩率A组 >B组 >C组 ,剖宫产率A组 相似文献