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Abstract：
OBJECTIVE: The sympathetic nervous and hormonal counterregulatory responses to hypoglycaemia differ between people with type 1 and type 2 diabetes and may change along the course of diabetes, but have not been directly compared. We aimed to compare counterregulatory hormone and symptom responses to hypoglycaemia between people with type 1 diabetes, insulin-treated type 2 diabetes and controls without diabetes, using a standardised hyperinsulinaemic-hypoglycaemic clamp.
METHODS: We included 47 people with type 1 diabetes, 15 with insulin-treated type 2 diabetes, and 32 controls without diabetes. Controls were matched according to age and sex to the people with type 1 diabetes or with type 2 diabetes. All participants underwent a hyperinsulinaemic-euglycaemic-(5.2 ± 0.4 mmol/L)-hypoglycaemic-(2.8 ± 0.13 mmol/L)-clamp.
RESULTS: The glucagon response was lower in people with type 1 diabetes (9.4 ± 0.8 pmol/L, 8.0 [7.0-10.0]) compared to type 2 diabetes (23.7 ± 3.7 pmol/L, 18.0 [12.0-28.0], p < 0.001) and controls (30.6 ± 4.7, 25.5 [17.8-35.8] pmol/L, p < 0.001). The adrenaline response was lower in type 1 diabetes (1.7 ± 0.2, 1.6 [1.3-5.2] nmol/L) compared to type 2 diabetes (3.4 ± 0.7, 2.6 [1.3-5.2] nmol/L, p = 0.001) and controls (2.7 ± 0.4, 2.8 [1.4-3.9] nmol/L, p = 0.012). Growth hormone was lower in people with type 2 diabetes than in type 1 diabetes, at baseline (3.4 ± 1.6 vs 7.7 ± 1.3 mU/L, p = 0.042) and during hypoglycaemia (24.7 ± 7.1 vs 62.4 ± 5.8 mU/L, p = 0.001). People with 1 diabetes had lower overall symptom responses than people with type 2 diabetes (45.3 ± 2.7 vs 58.7 ± 6.4, p = 0.018), driven by a lower neuroglycopenic score (27.4 ± 1.8 vs 36.7 ± 4.2, p = 0.012).
CONCLUSIONS: Acute counterregulatory hormone and symptom responses to experimental hypoglycaemia are lower in people with type 1 diabetes than in those with long-standing insulin-treated type 2 diabetes and controls.
METHODS: We included 47 people with type 1 diabetes, 15 with insulin-treated type 2 diabetes, and 32 controls without diabetes. Controls were matched according to age and sex to the people with type 1 diabetes or with type 2 diabetes. All participants underwent a hyperinsulinaemic-euglycaemic-(5.2 ± 0.4 mmol/L)-hypoglycaemic-(2.8 ± 0.13 mmol/L)-clamp.
RESULTS: The glucagon response was lower in people with type 1 diabetes (9.4 ± 0.8 pmol/L, 8.0 [7.0-10.0]) compared to type 2 diabetes (23.7 ± 3.7 pmol/L, 18.0 [12.0-28.0], p < 0.001) and controls (30.6 ± 4.7, 25.5 [17.8-35.8] pmol/L, p < 0.001). The adrenaline response was lower in type 1 diabetes (1.7 ± 0.2, 1.6 [1.3-5.2] nmol/L) compared to type 2 diabetes (3.4 ± 0.7, 2.6 [1.3-5.2] nmol/L, p = 0.001) and controls (2.7 ± 0.4, 2.8 [1.4-3.9] nmol/L, p = 0.012). Growth hormone was lower in people with type 2 diabetes than in type 1 diabetes, at baseline (3.4 ± 1.6 vs 7.7 ± 1.3 mU/L, p = 0.042) and during hypoglycaemia (24.7 ± 7.1 vs 62.4 ± 5.8 mU/L, p = 0.001). People with 1 diabetes had lower overall symptom responses than people with type 2 diabetes (45.3 ± 2.7 vs 58.7 ± 6.4, p = 0.018), driven by a lower neuroglycopenic score (27.4 ± 1.8 vs 36.7 ± 4.2, p = 0.012).
CONCLUSIONS: Acute counterregulatory hormone and symptom responses to experimental hypoglycaemia are lower in people with type 1 diabetes than in those with long-standing insulin-treated type 2 diabetes and controls.
摘要：
目的：1型和2型糖尿病患者对低血糖的交感神经和激素反调节反应不同，并且可能随着糖尿病的发展而改变。但没有直接比较。我们旨在比较1型糖尿病患者对低血糖的反调节激素和症状反应。胰岛素治疗的2型糖尿病和无糖尿病的对照，使用标准化的高胰岛素血症-低血糖钳夹。
方法：我们纳入了47名1型糖尿病患者，15患有胰岛素治疗的2型糖尿病，和32个没有糖尿病的对照。对照根据年龄和性别与1型糖尿病患者或2型糖尿病患者相匹配。所有参与者均接受高胰岛素血症-正常血糖-（5.2±0.4mmol/L）-低血糖-（2.8±0.13mmol/L）-钳夹。
结果：1型糖尿病患者的胰高血糖素反应较低（9.4±0.8pmol/L，8.0[7.0-10.0]）与2型糖尿病（23.7±3.7pmol/L，18.0[12.0–28.0]，p<0.001）和对照组（30.6±4.7，25.5[17.8-35.8]pmol/L，p<0.001)。1型糖尿病患者的肾上腺素反应(1.7±0.2,1.6[1.3-5.2]nmol/L)低于2型糖尿病患者(3.4±0.7,2.6[1.3-5.2]nmol/L,p=0.001）和对照（2.7±0.4，2.8[1.4-3.9]nmol/L，p=0.012)。2型糖尿病患者的生长激素低于1型糖尿病患者，在基线（3.4±1.6vs7.7±1.3mU/L，p=0.042）和低血糖期间（24.7±7.1vs62.4±5.8mU/L，p=0.001)。1型糖尿病患者的总体症状反应低于2型糖尿病患者（45.3±2.7vs58.7±6.4，p=0.018）。由较低的神经糖分（27.4±1.8vs36.7±4.2，p=0.012）驱动。
结论：1型糖尿病患者对实验性低血糖的急性反调节激素和症状反应低于长期胰岛素治疗的2型糖尿病患者和对照组。
方法：我们纳入了47名1型糖尿病患者，15患有胰岛素治疗的2型糖尿病，和32个没有糖尿病的对照。对照根据年龄和性别与1型糖尿病患者或2型糖尿病患者相匹配。所有参与者均接受高胰岛素血症-正常血糖-（5.2±0.4mmol/L）-低血糖-（2.8±0.13mmol/L）-钳夹。
结果：1型糖尿病患者的胰高血糖素反应较低（9.4±0.8pmol/L，8.0[7.0-10.0]）与2型糖尿病（23.7±3.7pmol/L，18.0[12.0–28.0]，p<0.001）和对照组（30.6±4.7，25.5[17.8-35.8]pmol/L，p<0.001)。1型糖尿病患者的肾上腺素反应(1.7±0.2,1.6[1.3-5.2]nmol/L)低于2型糖尿病患者(3.4±0.7,2.6[1.3-5.2]nmol/L,p=0.001）和对照（2.7±0.4，2.8[1.4-3.9]nmol/L，p=0.012)。2型糖尿病患者的生长激素低于1型糖尿病患者，在基线（3.4±1.6vs7.7±1.3mU/L，p=0.042）和低血糖期间（24.7±7.1vs62.4±5.8mU/L，p=0.001)。1型糖尿病患者的总体症状反应低于2型糖尿病患者（45.3±2.7vs58.7±6.4，p=0.018）。由较低的神经糖分（27.4±1.8vs36.7±4.2，p=0.012）驱动。
结论：1型糖尿病患者对实验性低血糖的急性反调节激素和症状反应低于长期胰岛素治疗的2型糖尿病患者和对照组。
