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DOI: 10.1055/s-0029-1239518
© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York
Nocturnal Blood Glucose and IGFBP-1 Changes in Type 1 Diabetes: Differences in the Dawn Phenomenon between Insulin Regimens
Publication History
received 14.06.2009
first decision 05.08.2009
accepted 24.08.2009
Publication Date:
15 October 2009 (online)
Abstract
Objective: Insulin-like growth factor binding protein-1 (IGFBP-1) is known to regulate the bioavailability of insulin-like growth factor (IGF) and the levels of IGFBP-1 are increased in the morning in patients with type 1 diabetes mellitus. We investigated the nocturnal fluctuations of glucose, IGFBP-1, and free IGF-1 levels with three insulin regimens.
Research Design and Methods: Forty-eight type 1 diabetes patients were divided into three groups according to their basal insulin therapy (continuous subcutaneous insulin infusion [CSII], insulin glargine, NPH insulin). Blood samples were obtained every 2 h between 2 300 h and 0700 h to measure plasma glucose, IGFBP-1 and free IGF-1 levels.
Results: The dawn phenomenon was more frequent with NPH (62.1%) than with glargine (16.6%, p<0.05) and CSII (14.3%, p<0.05). In the NPH group, the serum IGFBP-1 levels were markedly increased from 21.0±3.6 ng/ml at 2 300 h to 200.3±21.8 ng/ml at 0700 h and free IGF-1 levels were inversely decreased; these changes were partially suppressed in the CSII and glargine groups.
Conclusions: The use of insulin regimens that provide sufficient insulin levels in the early morning can suppress the dawn phenomenon, leading to improved glycemic control. The increase in circulating IGFBP-1 in the morning, as a result of waning of insulin action, lowers free IGF-1 levels and may cause insulin resistance.
Key words
insulin-like growth factor binding protein-1 - dawn phenomenon - type 1 diabetes mellitus
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Correspondence
H. YagasakiMD
Department of Pediatrics
Faculty of Medicine University of Yamanashi
1110 Shimokato, Chuo
409-3898 Yamanashi
Japan
Phone: +81 55-273-9606
Fax: +81 55-273-6745
Email: yagasaki@mwd.biglobe.ne.jp