Contribution of pancreatic α‐cell function to insulin sensitivity and glycemic variability in patients with type 1 diabetes. Issue 3 (30th October 2018)

• Record Type: Journal Article
• Authors: Takahashi, Nobuyuki; Chujo, Daisuke; Kajio, Hiroshi; Ueki, Kohjiro
• Is Part Of: Journal of diabetes investigation. Volume 10:Issue 3(2019)
• Page Start: 690
• Page End: 698
• Publication Date: 2018-10-30
• Subjects: Insulin sensitivity -- Pancreatic α‐cell -- Type 1 diabetes; Diabetes -- Periodicals; Diabetes -- Research -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462005
• DOI: 10.1111/jdi.12949
• Languages: English
• ISSNs: 2040-1116

Abstract

Abstract: Aims/Introduction: To evaluate the contribution of pancreatic α‐cell function to the dawn phenomenon, insulin sensitivity, hepatic glucose uptake and glycemic variability in patients with type 1 diabetes. Materials and Methods: In 40 patients with type 1 diabetes, arginine stimulation tests were carried out, and the area under the curve (AUC) of glucagon was measured using radioimmunoassays (AUCglc RIA ) and enzyme‐linked immunosorbent assays (AUCglc ELISA ). The ratio of the insulin dose delivered by an artificial pancreas to maintain euglycemia between 04.00 and 08.00 hours or between 00.00 and 04.00 hours was measured as the dawn index. The glucose infusion rate and hepatic glucose uptake were measured using hyperinsulinemic euglycemic clamp and clamp oral glucose loading tests. Glycemic variability in 96 h was measured by continuous glucose monitoring. Results: The median dawn index (1.7, interquartile range 1.0–2.8) was not correlated with AUCglc RIA ( R 2 = 0.03, P = 0.39) or AUCglc ELISA ( R 2 = 0.04, P = 0.32). The median glucose infusion rate (7.3 mg/kg/min, interquartile range 6.4–9.2 mg/kg/min) was significantly correlated with AUCglc RIA ( R 2 = 0.20, P = 0.02) and AUCglc ELISA ( R 2 = 0.21, P = 0.02). The median hepatic glucose uptake (65.3%, interquartile range 40.0–87.3%) was not correlated with AUCglc RIA ( R 2 = 0.07, P = 0.26) or AUCglc ELISA ( R 2 = 0.26, P = 0.79). The standard deviation of glucose levels measured by continuous glucose monitoring was significantly correlated with AUCglc RIA ( R 2 = 0.11, P = 0.049), but not with AUCglc ELISA ( R 2 = 0.01, P = 0.75). Conclusions: Pancreatic α‐cell function contributed to insulin sensitivity in patients with type 1 diabetes. Abstract : In this study, the area under the curve of the arginine‐stimulated plasma glucagon measured by both radioimmunoassay (RIA) and enzyme‐linked immunosorbent assay (ELISA), i.e., AUCglcRIA and AUCglcELISA, respectively, was found to be significantly correlated with glucose infusion rate by hyperinsulinemic euglycemic clamp tests in patients with type 1 diabetes. Moreover, the standard deviation of glucose levels in continuous glucose monitoring was significantly correlated with AUCglcRIA but not AUCglcELISA . Changes in insulin requirements between night and morning and hepatic glucose uptake, as evaluated by clamp oral glucose loading tests, were not correlated with AUCglcRIA or AUCglcELISA .