[CDS2010]GLP-1与糖尿病——Prof.Villsbol访谈
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专家访谈 作者:Prof.Villsbol访谈 来源:国际糖尿病 2010/11/22 11:14:00    加入收藏

内容概要:我认为这一影响有重要意义。在治疗2型糖尿病的过程中,我们发现了很多种重要的表现特征,其中主要的问题是胰岛素缺乏和升高的胰高血糖素。

  International Diabetes: According to recent research, GLP-1 receptor agonists treat type 2 diabetes by affecting both β cells and α cells. Do you believe that GLP-1 affect the secretion of glucagon is a significant effect?
 

      《国际糖尿病》:目前的研究提示GLP-1受体激动剂通过影响胰岛β细胞和α细胞来治疗2型糖尿病,请问您是否认为GLP-1影响胰岛分泌胰高血糖素具有重要意义?

  Prof. Vilsboll: I believe that there is a very significant effect.  When treating patients with type 2 diabetes there are many important phenotype characteristics, but one of the major problems is their insulin deficiency and their hyperglucagon.  High fasting glucagon is a major problem and actually we have seen a paradoxical increase in glucagon after both oral glucose and meal intake which increase the hepatic glucose production which deteriorates their glycemia control.  For many years the question has been asked “how much of the effect of GLP-1 is due to the stimulation of  insulin secretion and how much is due to the decrease in glucagon?”, and we evaluated that in patients with type 2 diabetes and just published a paper last year in Diabetes.  It is, of course, a whole-body physiology and we use somatostatin as a tool to evaluate this further. From that trial we actually saw that approximately 50%of the effect is due to the insulin tropic properties of GLP-1 and approximately 50% of the efficacy is due to glucagon, so it is of major importance.  That also goes hand-in-hand with the fact that we have just learned from both exenatide and liraglutide that the peptides actually work throughout the stages of diabetes, so the efficacy is not dependent on a very high β cell function; you actually also see a beautiful effect in those subjects who do not have much β cell and maybe the primary goal there would actually be glucagon.
 

        Vilsboll教授:我认为这一影响有重要意义。在治疗2型糖尿病的过程中,我们发现了很多种重要的表现特征,其中最主要的问题之一是胰岛素缺乏和升高的胰高血糖素。糖尿病患者本身的空腹胰高血糖素水平较高,口服葡萄糖和进餐后胰高血糖素会反常地升高,使肝糖原的合成增加,患者的血糖更难以控制。过去我们一直在研究GLP-1的作用中有多少是源于刺激胰岛素的分泌,又有多少是源于降低胰高血糖素的分泌。我们在2型糖尿病患者中进行了研究且试验结果已经发表在去年的Diabetes杂志上,在人体中应用生长抑素作为工具来进行评估的这项研究发现,GLP-1的作用中约50%来源于刺激胰岛素分泌,另外50%源于其对胰高血糖素的作用。这一发现有重要意义,也与以前观察到的艾塞那肽和利拉鲁肽在治疗糖尿病过程中所观察到的现象吻合。GLP-1的作用并不依赖于β细胞的明显升高,在那些β细胞数量很少的患者中也达到良好的血糖控制,这可能主要是胰高血糖素的作用。
 



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