Clinical Evaluation of Endogenous Insulin Secretion via Sulfonylurea Receptor and Insulin Sensitivity Estimated by the Nateglinide Administration Test in Type 2 Diabetics

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  • Omura Masao
    Department of Internal Medicine, Yokohama Rosai Hospital
  • Fujibayashi Kazutoshi
    Department of Internal Medicine, Kanto Medical Center NTT EC
  • Sakuma Nobuko
    Department of Internal Medicine, Social Insurance Central General Hospital
  • Mochizuki Kazuko
    Department of Clinical Laboratory, Social Insurance Central General Hospital
  • Araki Rie
    Department of Clinical Laboratory, Social Insurance Central General Hospital
  • Ishida Satomi
    Department of Clinical Laboratory, Social Insurance Central General Hospital
  • Saito Toshikazu
    Department of Internal Medicine, Social Insurance Central General Hospital

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Other Title
  • 2型糖尿病患者の内因性インスリン分泌能とインスリン感受性を同時評価可能なナテグリニド負荷試験の有用性に関する臨床的検討
  • 2ガタ トウニョウビョウ カンジャ ノ ナイインセイ インスリン ブンピツノウ ト インスリン カンジュセイ オ ドウジ ヒョウカ カノウナ ナテグリニド フカ シケン ノ ユウヨウセイ ニ カンスル リンショウテキ ケントウ

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Abstract

We attempted to estimate endogenous insulin secretion via sulfonylurea receptor and insulin sensitivity to endogenous insulin simultaneously using the nateglinide administration test. The levels of plasma glucose and serum immunoreactive insulin (IRI) were measured before and 30, 45, 60, and 75 min after oral administration of 60 mg of nateglinide. We investigated serum IRI n min after nateglinide administration (IRIn) associatied with CPR 120 min after standard meal intake (CPR120), and the nateglinide index n min after nateglinide administration (NGIn) associated with the rate constant for plasma glucose disappearance after insulin injection (Kitt). We found 27 subjects with a positive relationship between CPR120 and IRI60 (r=0.56, p=0.0023) and between Kitt and NGI60 (r=0.71, p<0.0001). In 50 type 2 diabetics, ROC analysis revealed that IRI60 was more sensitive and specific for screening for the indication of insulin therapy for screening for glycemic control than CPR120 when the cut-off value of IRI60 was 7.8 μU/ml. ROC analysis also showed that NGI60 sensitivity and specificity for screening for the insulin sensitizer were similar to those of Kitt when NGI60 was 1.0 0/000 min-1 μU-1. We concluded that IRI60 and NGI60 are clinically useful parameters in deciding how to treat type 2 diabetics.

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