课件：型糖尿病的现代治疗(年).ppt

DISCUSSION POINTS: Data illustrate the incretin effect. The plasma insulin response to intravenous glucose was less than half of that seen after oral glucose ingestion, indicating that in addition to plasma glucose, alimentary mechanism(s) (incretins) regulate insulin secretion. An incretin is a substance released by the gut into circulation in response to food intake, which exhibits actions including glucose dependent enhancement of insulin secretion. SLIDE BACKGROUND: DISCUSSION POINTS: GLP-1, a product of the proglucagon gene of the intestinal L-cells, is released rapidly in response to meals. It is a potent glucose-dependent insulinotropic hormone (enhances insulin secretion in response to a elevated glucose levels). Its release is impaired in patients with type 2 diabetes and its precursor, impaired glucose tolerance (IGT). SLIDE BACKGROUND: DISCUSSION POINTS: GLP-1 is a proglucagon derived peptide. The liberation of GLP-1 in the intestine, but not the pancreas, appears to be due to tissue specific expression of pro-hormone convertase 1/3 in the enteroendocrine cells of the intestines. The major products of the proglucagon molecule in the pancreas are glucagon and major proglucagon fragment (MPGF), while those of the intestine are: glicentin, oxyntomodulin, GLP-1, GLP-2 and intervening peptide. SLIDE BACKGROUND: DISCUSSION POINTS: These data show that postprandial GLP-1 concentrations are reduced in subjects with type 2 diabetes and impaired glucose tolerance (IGT). The top line represents GLP-1 concentrations in subjects with normal glucose tolerance (NGT). GLP-1 concentrations are statistically significantly reduced in patients with type 2 diabetes compared to NGT subjects from t=60 min to 150 min. Slide Background: Fifty-four subjects with type 2 diabetes (BMI 30.2 kg/m2, age 55.9 y, A1C 8.4%), 15 IGT (BMI 35.0 kg/m2, age 55.3 y, A1C 6.1%), and 33 NGT (BMI 29.6 kg/m2, age 56.2 y, A1C 5.9%). All antidiabetic medications were discontinued 3 days pr