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[Insulin secretion and sensitivity in patients with secondary failure to oral hypoglycemic drugs]
G López1, M Calvillán, P Durruty
1Unidad de Diabetes y Nutrición, Facultad de Medicina, Universidad de Chile.
Abstract:
Secretion and peripheral sensitivity to insulin was investigated in diabetic patients with secondary failure to oral hypoglycemic drugs. 8 patients with secondary failure (non responders), 7 non insulin dependent diabetic patients with good response to oral drugs (responders) and 8 control subjects were studied. Insulin secretion was determined with peptide C in urine obtained 4h after a 500 Cal breakfast; in vivo insulin sensitivity was studied by the euglycemic hyperinsulinemic clamp technique. All groups were comparable in age, nutritional status and duration of diabetes. Non responders had higher fasting blood sugar levels compared to responders (228 +/- 70 vs 136 +/- 21 mg/dl, p < 0.05). Controls had lower blood sugar levels than the other 2 groups (93 +/- 8, p < 0.05). Insulin levels were similar in non responders and responders (24 +/- 12 and 16 +/- 9 uU/ml, respectively) and higher than in controls (10 +/- 3, p < 0.05). Peptide C was lower in non responders than in responders (3.8 +/- 1 vs 5.3 +/- 1.4 nm/4h, respectively, p < 0.04), but similar to controls (4.4 +/- 1.2). No difference in secretion of insulin was noted between non responders and responders. Insulin sensitivity index was 3.67 +/- 1.41 ((mg/kg.min)/(uU/ml)). 100 in non responders and 4.20 +/- 1.14 in responders; the index for controls was 7.92 +/- 1.70 (p < 0.05). These results show that non responders have normal insulin levels, although inappropriate for the level of hyperglycemia. Insulin sensitivity in non responders is similar to responders but lower than controls.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Patients with secondary failure to oral hypoglycemic drugs exhibit normal insulin levels but reduced insulin sensitivity, indicating impaired glucose regulation despite adequate insulin secretion.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Diabetes Mellitus Research
Background:
- Type 2 diabetes management often involves oral hypoglycemic agents.
- Secondary failure to oral hypoglycemic drugs necessitates further investigation into underlying mechanisms.
- Understanding insulin secretion and sensitivity is crucial for managing diabetes progression.
Purpose of the Study:
- To investigate insulin secretion and peripheral insulin sensitivity in diabetic patients experiencing secondary failure to oral hypoglycemic drugs.
- To compare these parameters between non-responders, responders, and healthy controls.
Main Methods:
- Studied 8 non-responders, 7 responders, and 8 controls, comparable in age, nutritional status, and diabetes duration.
- Assessed insulin secretion via urinary peptide C measurements post-breakfast.
- Evaluated in vivo insulin sensitivity using the euglycemic hyperinsulinemic clamp technique.
Main Results:
- Non-responders had significantly higher fasting blood sugar levels than responders and controls.
- Insulin levels were similar in non-responders and responders, but higher than controls.
- Urinary peptide C was lower in non-responders compared to responders, but similar to controls, indicating no difference in insulin secretion.
- Insulin sensitivity index was significantly lower in both non-responders and responders compared to controls.
Conclusions:
- Patients with secondary failure to oral hypoglycemic drugs demonstrate normal insulin levels, though inappropriately high for their hyperglycemia.
- Insulin sensitivity in non-responders is comparable to responders but markedly reduced compared to healthy individuals.
- These findings suggest impaired insulin sensitivity as a key factor in secondary drug failure in type 2 diabetes.