口服インスリン投与と,最近発症した1型糖尿病における残留β細胞機能:多センターランダム化対照試験. 糖尿病 インスリン・オラル グループ
L Chaillous1, H Lefèvre, C Thivolet
1Centres Hospitaliers Universitaires de Nantes, France. lucy.chaillous@wanadoo.fr
Lancet (London, England)
|August 19, 2000
まとめ
口服インスリンは,最近発症した1型糖尿病患者のベータ細胞機能を保たなかった. この研究では,プラセボと比較して,C-ペプチドレベルやインスリン需要の違いは見つかりませんでした.
科学分野:
- 免疫学 免疫学とは
- エンドクリノロジー エンドクリノロジー
- メタボリック疾患
背景:
- オートアンチゲンの経口投与は,動物モデルでのベータ細胞破壊を遅らせることを有望に示しています.
- 最近発症した1型糖尿病では,残留ベータ細胞機能を保存する口服インスリンの可能性を調査することは極めて重要です.
研究 の 目的:
- 再結合ヒトインスリンを経口投与することで,最近発症した1型糖尿病におけるベータ細胞機能を保護できるかどうかを判断する.
- 口服インスリンがCペプチドレベルとインスリン需要に与える影響を評価する.
主な方法:
- 最近発症した1型糖尿病の自己抗体陽性患者131人をランダムに分け,口服インスリン2.5mgまたは7.5mgまたはプラセボを1年間毎日投与しました.
- ベータ細胞の機能は,断食状態と刺激されたCペプチド濃度を測定することによって評価されました.
- 分析は,治療の意図に基づいて行われました.
主要な成果:
- 経口インスリン群とプラセボ群の間で,皮膚下に投与されるインスリン,HbA1c,または空腹/刺激されたCペプチド濃度の有意な差異は12ヶ月後に観察されなかった.
- 年齢も,Cペプチドのベースラインレベルも,治療結果に影響を与えない.
- 共通のベータ細胞抗原に対する抗体の位数において,差異は検出されなかった.
結論:
- 口服インスリンは,試験された用量では,最近発症した1型糖尿病患者のベータ細胞機能の悪化を防ぐことはできませんでした.
- 異なる投与戦略や患者集団を調査するために,さらなる研究が必要になる可能性があります.
関連する概念動画
Oral Hypoglycemic Agents: Biguanides and Glitazones
Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood glucose levels...
Oral Hypoglycemic Agents: Glinides
Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively manages...
Oral Hypoglycemic Agents: α-Glucosidase Inhibitors
α-glucosidase inhibitors, including acarbose (Precose), miglitol (Glyset), and voglibose (Voglib) (primarily available in Asia), are drugs that control blood sugar levels by delaying the digestion of starch and disaccharides. They achieve this by inhibiting α-glucosidase enzymes in the intestine, which slow the absorption of carbohydrates in the intestine, which in turn leads to a prolonged release of the glucoregulatory hormone GLP-1 from intestinal L-cells.
Acarbose and miglitol are typically...
Acarbose and miglitol are typically...
Glucagon-like Receptor Agonists
Incretins include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which stimulate insulin secretion post-meals. In type 2 diabetes, GIP's efficacy is reduced, making GLP-1 a viable drug target. GIP originates from preproGIP.
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by the...
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by the...
Hypoglycemia
Hypoglycemia is a blood glucose level below 70 mg/dL. It commonly occurs in individuals using insulin or insulin-secreting drugs, but may also arise in non-diabetic conditions. People with type 1 diabetes are at the highest risk because they depend on exogenous insulin. People with type 2 diabetes are also at risk, especially when treated with insulin or medications such as sulfonylureas, which increase insulin release regardless of blood glucose levels. It develops when insulin levels exceed...
Hyperglycemia
Hyperglycemia is an abnormally high blood glucose level. It is diagnosed by fasting glucose ≥126 mg/dL, 2-hour oral glucose tolerance test (or OGTT) ≥200 mg/dL, random glucose ≥200 mg/dL with symptoms, or HbA1c ≥6.5%. However, HbA1c results may be unreliable in certain conditions, such as anemia or hemoglobinopathies, and the diagnosis should be confirmed unless classic symptoms are present. Postprandial hyperglycemia is typically considered significant when glucose levels exceed 180 mg/dL two...


