ABSTRACT
To elucidate the causes of the diminished incretin effect in type 2 diabetes mellitus we investigated the secretion of the incretin hormones, glucagon-like peptide-1 and glucose- dependent insulinotropic polypeptide and measured nonesterified fatty acids, and plasma concentrations of insulin, C peptide, pancreatic polypeptide, and glucose during a 4-h mixed meal test in 54 heterogeneous type 2 diabetic patients, 33 matched control subjects with normal glucose tolerance, and 15 unmatched subjects with impaired glucose tolerance. The glucagon-like peptide-1 response in terms of area under the curve from 0-240 min after the start of the meal was significantly decreased in the patients (2482 +/- 145 compared with 3101 +/- 198 pmol/liter.240 min; P = 0.024). In addition, the area under the curve for glucose-dependent insulinotropic polypeptide was slightly decreased. In a multiple regression analysis, a model with diabetes, body mass index, male sex, insulin area under the curve (negative influence), glucose-dependent insulinotropic polypeptide area under the curve (negative influence), and glucagon area under the curve (positive influence) explained 42% of the variability of the glucagon-like peptide-1 response. The impaired glucose tolerance subjects were hyperinsulinemic and generally showed the same abnormalities as the diabetic patients, but to a lesser degree. We conclude that the meal-related glucagon-like peptide-1 response in type 2 diabetes is decreased, which may contribute to the decreased incretin effect in type 2 diabetes.
Subject(s)
Diabetes Mellitus, Type 2/blood , Glucagon/metabolism , Glucose Intolerance/blood , Peptide Fragments/metabolism , Peptides/metabolism , Protein Precursors/metabolism , Analysis of Variance , Autoantibodies/blood , Blood Glucose/metabolism , C-Peptide/blood , Diabetes Mellitus, Type 2/physiopathology , Fasting , Fatty Acids, Nonesterified/blood , Female , Gastric Inhibitory Polypeptide/blood , Glucagon/blood , Glucagon-Like Peptide 1 , Glucose Intolerance/physiopathology , Glutamate Decarboxylase/immunology , Glycated Hemoglobin/analysis , Humans , Insulin/blood , Male , Middle Aged , Pancreatic Polypeptide/blood , Peptide Fragments/blood , Peptides/blood , Protein Precursors/blood , Reference ValuesSubject(s)
Antidotes/administration & dosage , Charcoal/administration & dosage , Inactivation, Metabolic , Poisoning/therapy , Acute Disease , Drug Overdose/drug therapy , Drug Overdose/metabolism , Drug Overdose/therapy , Emergencies , Emetics/administration & dosage , Humans , Ipecac/administration & dosage , Poisoning/drug therapy , Poisoning/metabolism , Randomized Controlled Trials as TopicSubject(s)
Drug Overdose/therapy , Inactivation, Metabolic , Poisoning/therapy , Antidotes/administration & dosage , Antidotes/adverse effects , Charcoal/administration & dosage , Charcoal/adverse effects , Contraindications , Drug Overdose/drug therapy , Drug Overdose/metabolism , Emetics/administration & dosage , Emetics/adverse effects , Gastric Lavage/adverse effects , Guidelines as Topic , Humans , Intestines , Ipecac/administration & dosage , Ipecac/adverse effects , Poisoning/drug therapy , Poisoning/metabolism , Therapeutic Irrigation/adverse effectsSubject(s)
Aspirin/poisoning , Poisoning/therapy , Alkalies , Aspirin/urine , Diuresis , Humans , Poisoning/urineABSTRACT
Two cases of fulminant pneumococcal septicaemia are reported. These occurred 18 and 25 years after splenectomy. These patients had not received pneumococcal vaccination. Disseminated intravascular coagulation developed early and was of decisive significance for the course of the illness with lethal issue. The characteristic clinical picture in pneumococcal speticaemia in asplenic patients may be misinterpreted initially as influenza and meticulous observation is therefore necessary and antibiotic treatment according to current guidelines should be initiated as early possible in febrile episodes.
