目的:肠促胰岛素在2型糖尿病中作用减弱的机制尚不确定,但是有人建议迷走神经传播受损。我们的目的是研究肠促胰岛素效应与自主神经病变之间的关系,以及血糖异常的程度和糖尿病的持续时间。
方法:对于横断面研究,我们纳入了长期2型糖尿病患者,最近发病,未经治疗的糖尿病和没有糖尿病的对照年龄相匹配,性别和体重指数。用心血管反射试验评估自主神经功能,心率变异性和sudomotor功能。对肠道内脏传入神经进行了快速直肠球囊扩张测试。进行了口服葡萄糖耐量试验和静脉内等糖葡萄糖输注,以计算肠促胰岛素作用和胃肠道介导的葡萄糖处置(GIGD)。
结果:招募了65名参与者。糖尿病患者有最早感觉的直肠敏感(长期3.7±1.1kPa,4.0±1.3inearly),与对照组(3.0±0.9kPa)相比,p=.005。最早感觉的直肠敏感率与肠促胰岛素效应无关(rho=-0.204,p=.106),但发现与GIGD有关联(rho-0.341,p=0.005)。肠促胰岛素作用和GIGD与所有葡萄糖值相关,HbA1c和糖尿病的持续时间。
结论:在长期和早期2型糖尿病中均发现直肠低敏感性,与肠促胰岛素效应无关,但是有了GIGD,暗示内脏神经病和胃肠道葡萄糖处理之间的潜在联系。肠促胰岛素作用和GIGD均与血糖异常程度和糖尿病持续时间相关。
■一些数据先前已在美国糖尿病协会第83届科学会议上发表并作为海报呈现:Meling等人;1658-P:直肠低敏感性,肠道自主神经功能障碍的潜在标志物,与2型糖尿病患者的胃肠道介导的葡萄糖处置显着相关。糖尿病2023年6月20日;72(补充1):1658-P。https://doi.org/10.2337/db23-1658-P
OBJECTIVE: The mechanisms behind the diminished incretin effect in type 2 diabetes are uncertain, but impaired vagal transmission has been suggested. We aimed to investigate the association between the incretin effect and autonomic neuropathy, and the degree of dysglycaemia and duration of diabetes.
METHODS: For a cross-sectional study, we included participants with either longstanding type 2 diabetes, recent onset, untreated diabetes and controls without diabetes matched for age, sex and body mass index. Autonomic nerve function was assessed with cardiovascular reflex tests, heart rate variability and sudomotor function. Visceral afferent nerves in the gut were tested performing rapid rectal balloon distention. An oral glucose tolerance test and an intravenous isoglycaemic glucose infusion were performed to calculate the incretin effect and gastrointestinal-mediated glucose disposal (GIGD).
RESULTS: Sixty-five participants were recruited. Participants with diabetes had rectal hyposensitivity for earliest sensation (3.7 ± 1.1 kPa in longstanding, 4.0 ± 1.3 in early), compared to controls (3.0 ± 0.9 kPa), p = .005. Rectal hyposensitivity for earliest sensation was not associated with the incretin effect (rho = -0.204, p = .106), but an association was found with GIGD (rho -0.341, p = .005). Incretin effect and GIGD were correlated with all glucose values, HbA1c and duration of diabetes.
CONCLUSIONS: Rectal hyposensitivity was uncovered in both longstanding and early type 2 diabetes, and was not associated with the incretin effect, but with GIGD, implying a potential link between visceral neuropathy and gastrointestinal handling of glucose. Both the incretin effect and GIGD were associated with the degree of dysglycaemia and the duration of diabetes.
UNASSIGNED: Some of the data have previously been published and presented as a poster on the American Diabetes Association 83rd Scientific Sessions: Meling et al; 1658-P: Rectal Hyposensitivity, a Potential Marker of Enteric Autonomic Nerve Dysfunction, Is Significantly Associated with Gastrointestinally Mediated Glucose Disposal in Persons with Type 2 Diabetes. Diabetes 20 June 2023; 72 (Supplement_1): 1658-P. https://doi.org/10.2337/db23-1658-P.