PMID- 25092686
OWN - NLM
STAT- MEDLINE
DCOM- 20150427
LR  - 20181202
IS  - 1935-5548 (Electronic)
IS  - 0149-5992 (Linking)
VI  - 37
IP  - 11
DP  - 2014 Nov
TI  - Glucose counterregulation in advanced type 2 diabetes: effect of beta-adrenergic 
      blockade.
PG  - 3040-6
LID - 10.2337/dc14-0782 [doi]
AB  - OBJECTIVE: To examine counterregulatory glucose kinetics and test the hypothesis 
      that beta-adrenergic blockade impairs these in patients with type 2 diabetes 
      mellitus (T2DM) and advanced beta-failure. RESEARCH DESIGN AND METHODS: Nine 
      insulin-requiring T2DM subjects and six matched nondiabetic control subjects were 
      studied. beta-Cell function was assessed by the C-peptide response to arginine 
      stimulation. Counterregulatory hormonal responses and glucose kinetics were 
      assessed by hyperinsulinemic euglycemic-hypoglycemic clamps with [3-(3)H]glucose 
      infusion. T2DM subjects underwent two clamp experiments in a randomized crossover 
      fashion: once with infusion of the beta-adrenergic antagonist propranolol and once 
      with infusion of normal saline. RESULTS: Compared with the control subjects, T2DM 
      subjects had threefold reduced C-peptide responses to arginine stimulation. 
      During the hypoglycemic clamp, glucagon responses were markedly diminished (16.0 
      +/- 4.2 vs. 48.6 +/- 6.0 ng/L, P < 0.05), but other hormonal responses and the 
      decrement in the required exogenous glucose infusion rate (GIR) from the 
      euglycemic clamp were normal (-10.4 +/- 1.1 vs. -7.8 +/- 1.9 micromol . kg(-1) . min(-1) 
      in control subjects); however, endogenous glucose production (EGP) did not 
      increase (-0.8 +/- 1.0 vs. 2.2 +/- 0.7 micromol . kg(-1) . min(-1) in control subjects, P 
      < 0.05), whereas systemic glucose disposal decreased normally. beta-Adrenergic 
      blockade in the T2DM subjects increased GIR  approximately 20% during the euglycemic clamp (P < 
      0.01), but neither increased GIR during the hypoglycemic clamp or decreased its 
      decrement from the euglycemic clamp to the hypoglycemic clamp. CONCLUSIONS: 
      Overall glucose counterregulation is preserved in advanced T2DM, but the 
      contribution of EGP is diminished. beta-Adrenergic blockade may increase insulin 
      sensitivity at normoglycemia but does not impair glucose counterregulation in 
      T2DM patients, even those with advanced beta-cell failure.
CI  - (c) 2014 by the American Diabetes Association. Readers may use this article as long 
      as the work is properly cited, the use is educational and not for profit, and the 
      work is not altered.
FAU - Bokhari, Syed
AU  - Bokhari S
AD  - Phoenix VA Medical Center, Phoenix, AZ.
FAU - Plummer, Elena
AU  - Plummer E
AD  - Phoenix VA Medical Center, Phoenix, AZ.
FAU - Emmerson, Peter
AU  - Emmerson P
AD  - Phoenix VA Medical Center, Phoenix, AZ.
FAU - Gupta, Anchal
AU  - Gupta A
AD  - Phoenix VA Medical Center, Phoenix, AZ.
FAU - Meyer, Christian
AU  - Meyer C
AD  - Phoenix VA Medical Center, Phoenix, AZ christian.meyer@flhosp.org.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20140804
PL  - United States
TA  - Diabetes Care
JT  - Diabetes care
JID - 7805975
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (C-Peptide)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
RN  - 9007-92-5 (Glucagon)
RN  - IY9XDZ35W2 (Glucose)
SB  - IM
MH  - Adrenergic beta-Antagonists/*pharmacology
MH  - C-Peptide/metabolism
MH  - Case-Control Studies
MH  - Cross-Over Studies
MH  - Diabetes Mellitus, Type 2/drug therapy/*physiopathology
MH  - Female
MH  - Glucagon/metabolism
MH  - Glucose/*metabolism
MH  - Glucose Clamp Technique
MH  - Humans
MH  - Hypoglycemic Agents/therapeutic use
MH  - Insulin/therapeutic use
MH  - *Insulin Resistance
MH  - Insulin-Secreting Cells/metabolism
MH  - Male
MH  - Middle Aged
MH  - Single-Blind Method
EDAT- 2014/08/06 06:00
MHDA- 2015/04/29 06:00
CRDT- 2014/08/06 06:00
PHST- 2014/08/06 06:00 [entrez]
PHST- 2014/08/06 06:00 [pubmed]
PHST- 2015/04/29 06:00 [medline]
AID - dc14-0782 [pii]
AID - 10.2337/dc14-0782 [doi]
PST - ppublish
SO  - Diabetes Care. 2014 Nov;37(11):3040-6. doi: 10.2337/dc14-0782. Epub 2014 Aug 4.