糖尿病口服降糖药进展教材教学课件.pptVIP

Major discussion point: INtestine SeCRETion INsulin Creutzfeldt W, Ebert R. New developments in the incretin concept. Diabetologia. 1985;28:565-573. Major discussion point: There have been 2 important incretins identified thus far: GLP-1 (glucagon-like peptide 1) and GIP (originally “gastric inhibitory polypeptide,” but it was later determined that GIP did not inhibit gastric function and the name was changed to “glucose-dependent insulinotropic polypeptide,” retaining the GIP acronym). Both of these peptides share amino acid sequences similar to those found in glucagon. Drucker DJ. Enhancing incretin action for the treatment of type 2 diabetes. Diabetes Care. 2003;26:2929-2940. 讨论 这里比较了胰高糖素样肽1 (GLP-1)和葡萄糖依赖的促胰岛素多肽 (GIP) 的特性和生物学作用。 背景 糖尿病患者中的GLP-1分泌减少，由小肠远端和结肠释放。 GLP-1刺激胰岛素分泌，抑制胃排空，抑制胰高糖素分泌，减少进食量，减轻体重，促进β细胞量增多。 糖尿病患者中GIP分泌正常，由十二指肠释放。 GIP刺激胰岛素分泌，对胃排空的作用很小，对胰高糖素分泌没有影响，对饱胀感和体重没有调节作用，可促使β细胞量增多。 Drucker DJ. Diabetes Care. 2003;26:2929-2940. Plasma Concentrations of Glucagon, Pancreatic Polypeptide, and GIP in Patients With Type 2 Diabetes and Normal Subjects1 A clinical study investigated the meal-stimulated GLP-1, GIP, and glucagon responses in patients with type 2 diabetes (n=54) vs matched control subjects with normal glucose tolerance (NGT) (n=33) and unmatched subjects with impaired glucose tolerance (IGT) (n=15). After an overnight fast following 3 days without antidiabetic medication, subjects consumed a mixed meal and underwent blood sampling periodically for 4 hours. the fasting GIP level in the T2DM was insignificantly higher than those in the NGT and IGT group. The GIP meal response (Table 2 and Fig. 2) was slightly, but significantly (P 0.047), decreased in the T2DM compared with the NGT group, but this difference was absent in the BMI and gender-corrected ANOVA analysis for all three groups. Peak values were similar in all groups. Fasting GLP-1 concentrations were significantly higher in T2DM than in NGT (Table 1), but there wa