目的:为了评估潜在的血糖,溴隐亭快速释放(BCQR)对青少年和成人1型糖尿病患者的肾脏和血管益处。
方法:40名青少年和40名12-60岁的1型糖尿病成年人被纳入双盲研究,安慰剂对照,早上用BCQR治疗4周的随机顺序交叉研究(每周从0.8mg至1.6mg至3.2mg,最小剂量1.6毫克)。每个阶段后的研究评估包括血压(BP),脂质,外周动脉僵硬度和自主神经功能,混合膳食耐受性测试,连续血糖监测(CGM),肌酐,估计肾小球滤过率,估计的胰岛素敏感性,胰岛素剂量和间接量热法。
结果:青少年显示基线高血糖,胰岛素抵抗,与成人相比,代谢功能障碍和肾滤过增加。在这两个年龄组中,连续血糖监测措施,估计的胰岛素敏感性和胰岛素剂量与BCQR治疗没有差异.在青少年中,BCQR降低收缩压,舒张压和三角指数增加血肌酐。在成年人中,收缩压,平均动脉压,全身血管阻力,混合餐耐量试验葡萄糖和胰高血糖素样肽1曲线下面积较低,BCQR的收缩压直立下降更大。
结论:高血糖,胰岛素抵抗,青少年的代谢功能障碍和肾脏高滤过表明,在这一高危年龄段,人们的注意力会增加.尽管BCQR对血糖或胰岛素敏感性影响不大,最初的血管和肾脏反应提示BCQR对需要进一步研究的青少年和成人1型糖尿病患者的潜在益处.
To evaluate the potential for glycaemic, renal and vascular benefits of
bromocriptine quick release (BCQR) in adolescents and adults with type 1 diabetes.
Forty adolescents and 40 adults with type 1 diabetes aged 12-60 years old were enrolled in a double-blind, placebo-controlled, random order crossover
study of 4 weeks of treatment in the morning with BCQR (titrated weekly from 0.8 mg to 1.6 mg to 3.2 mg, minimum dose 1.6 mg).
Study assessments after each phase included blood pressure (BP), lipids, peripheral arterial stiffness and autonomic function, mixed meal tolerance test, continuous glucose monitoring (CGM), creatinine, estimated glomerular filtration rate, estimated insulin sensitivity, insulin dose and indirect calorimetry.
Adolescents displayed baseline hyperglycaemia, insulin resistance, metabolic dysfunction and increased renal filtration compared with adults. In both age groups, continuous glucose monitoring measures, estimated insulin sensitivity and insulin dose did not differ with BCQR treatment. In adolescents, BCQR decreased systolic BP, diastolic BP and triangular index and increased serum creatinine. In adults, systolic BP, mean arterial pressure, systemic vascular resistance, and mixed meal tolerance test glucose and glucagon-like peptide 1 areas under the curve were lower, and the orthostatic drop in systolic BP was greater with BCQR.
Greater hyperglycaemia, insulin resistance, metabolic dysfunction and renal hyperfiltration in adolescents argues for increased attention during this high-risk age period. Although BCQR had little impact on glycaemia or insulin sensitivity, initial vascular and renal responses suggest potential benefits of BCQR in adolescents and adults with type 1 diabetes requiring further
study.