ALPHA-GLUCOSIDASE INHIBITORS - 10/09/11
Résumé |
Alterations in the composition and caloric content of the diet have profound influences on the development of non–insulin-dependent diabetes mellitus (NIDDM) and the treatment of all individuals with diabetes mellitus.38, 44 The peak rise in blood glucose following a meal is normally limited to approximately 30 to 50 mg/dL and is the result of the net balance between the rate of carbohydrate being absorbed from the gastrointestinal tract and the rate at which it is taken up by the liver and peripheral tissues. The factors controlling this balance are (1) the rate of nutrient propulsion through the gastrointestinal tract, (2) the quantity and kinetics of the digestive enzymes, (3) the rate and quantity of insulin secreted, and (4) the responsiveness of the liver and peripheral tissues to the secreted insulin. Although the insulin secretory response to ingested carbohydrate is determined by the rise in blood glucose, it is also amplified by the secretion of nutrient-stimulated gastrointestinal hormones such as gastric inhibitory polypeptide (GIP) and glucagonlike peptide 1 (GLP-1).17, 29
Dietary interventions to control hyperglycemia and diabetic dyslipidemia are the cornerstone of treatment for diabetic patients.38 In patients with insulin-dependent diabetes mellitus (IDDM), dietary management is integrated with insulin treatment to minimize early postprandial hyperglycemia and prevent late postprandial hypoglycemia. In patients with NIDDM, dietary management, although frequently focused on weight reduction, is also directed specifically at the management of hyperglycemia. Several studies have shown that short-term severe caloric restriction will lower fasting plasma glucose dramatically and increase insulin secretory function, and that this is not related to weight loss.16
These types of observations led to the hypothesis that drugs which act on the gastrointestinal tract to interfere with carbohydrate digestion might be useful agents in the treatment of diabetes.45 Fifteen years of clinical investigation have provided evidence that such a therapeutic approach does indeed benefit diabetic individuals and has some unique characteristics.
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| Address reprint requests to Harold E. Lebovitz, MD, Professor of Medicine, Chief, Endocrinology, Metabolism, and Diabetes, State University of New York, Health Science Center at Brooklyn, Box 1205, 450 Clarkson Ave, New York, New York 11203 |
Vol 26 - N° 3
P. 539-551 - septembre 1997 Retour au numéro
Article précédent
- METFORMIN
- Patrick M. Bell, David R. Hadden
- THIAZOLIDINEDIONES
- Robert R. Henry
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