Postprandial paradoxical IGFBP-1 response in obese type 2 diabetes patients
Résumé
The insulin-like growth factors (IGFs), which in free form induce glucose and amino acid uptake, circulate bound to IGFBP which modulate the bioavailability and activity of IGF-1. The aim of this study was to examine the effect of a standard meal on the serum levels of IGFBP-1 in obese type 2 diabetes patients, non obese type 1 diabetes and healthy controls, during a mixed meal (550 kcal), using the artificial pancreas (Biostator®) to obtain a normal glycemic response to the meal. IGFBP-1 decreased 50 percent during two hours following the meal both in the controls and in type 1 diabetes patients with similar clearance rate, but no significant decline was seen in the type 2 diabetes group in spite of several fold increase in insulin levels. The type 2 diabetes patients were also studied during Sandostatin® infusion to decrease the inappropriate secretion of glucagon during the meal. During the 210 minutes somatostatin infusion the glucagon response was suppressed and the IGFBP-1 levels increased concomitantly with insulin peak without any significant decline after the meal. In conclusion the impaired IGFBP-1 response to meal related hyperinsulinemia in obese type 2 diabetes patients suggests a decreased availability of active IGF-1, leading to a decrease in glucose uptake during and after a meal in the obese type 2 diabetes patients. The stimulated meal response to glucagon which contributes to postprandial hyperglycemia could not explain the increase in serum IGFBP-1 in these obese type 2 diabetes patients.
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