那格列奈降低2型糖尿病患者餐后血浆非对称性二甲基精氨酸水平的研究

Nateglinide decreases postprandial plasma ADMA levels in patients with newly diagnosed type 2 diabetes

目的比较那格列奈和阿卡波糖对新诊断2型糖尿病患者餐后血糖、血清胰岛素、血浆非对称性二甲基精氨酸(ADMA)水平的影响。方法16例新诊断的2型糖尿病患者进行为期9周的自身交叉对照研究,两种药物治疗前后测定空腹和标准餐后血糖、胰岛素和血浆ADMA水平,并用HOMA模型对胰岛素抵抗状态进行评价。结果120mg那格列奈和50mg阿卡波糖降低餐后血糖的效果相似;那格列奈显著恢复早时相胰岛素分泌,并有改善胰岛素抵抗的趋势[HOMA-IR 3.1±1.7vs2.8±1.9];与阿卡波糖相比,那格列奈能显著降低餐后240min血浆ADMA水平[(0.75±0.22)μmol/L vs(0.64±0.14)μmol/L]。结论那格列奈降低餐后血浆ADMA水平可能与其恢复早时相胰岛素分泌和改善胰岛素抵抗有关,提示那格列奈在改善进餐后的血管内皮功能障碍方面可能优于阿卡波糖。

Objective To investigate the effects of nateglinide versus acarbose on the levels of postprandial glucose, serum insulin, and plasma asymmetric dimethylarginine （ADMA） in patients with newly diagnosed type 2 diabetes. Methods A crossover trial of nateglinide and acarbose was conducted on 16 newly diagnosed type 2 diabetes patients during a period of 9 weeks. Plasma glucose, serum insulin, and plasma ADMA levels at fasting and after a standard meal were measured before and after treatment with both agents. Insulin resistance index was assessed using homeostasis model. Results The effects of 120 mg nateglinide and 50 mg acarbose on postprandial hyperglycemia in patients with type 2 diabetes were similar. Nateglinide could significantly stimulate early phase insulin release and was seemed to slightly improve insulin resistance （HOMA-IR 3.1 ±1.7 vs 2.8 ±1.9）. Compared to acarbose, nateglinide remarkably decreased the postprandial levels of plasma ADMA [ （0.75±0.22）vs （0.64±0.14）μmol/L]. Conclusions The results suggest that the reduction of postprandial ADMA level induced by nateglinide may be associated with the restoration of early phase insulin secretion and the improvement of insulin sensitivity and nateglinide may be better for improving post-meal epithelial dysfunction than acarbose.