Effect of cigarette smoking and of a transdermal nicotine delivery system on glucoregulation in type 2 diabetes mellitus

• Published in: European journal of clinical pharmacology Vol. 43; no. 3; p. 257
• Main Authors: Epifano, L, Di Vincenzo, A, Fanelli, C, Porcellati, F, Perriello, G, De Feo, P, Motolese, M, Brunetti, P, Bolli, G B
• Format: Journal Article
• Language: English
• Published: Germany 01.09.1992
• Subjects: Administration, Cutaneous; Blood Glucose - metabolism; Diabetes Mellitus, Type 2 - metabolism; Fatty Acids, Nonesterified - blood; Female; Humans; Hydroxybutyrates - metabolism; Insulin - blood; Insulin - metabolism; Insulin Secretion; Liver - metabolism; Male; Middle Aged; Nicotine - administration & dosage; Nicotine - adverse effects; Nicotine - pharmacology; Oxidation-Reduction; Smoking - metabolism
• ISSN: 0031-6970
• DOI: 10.1007/BF02333019

The effect of nicotine absorbed transdermally from a patch (TNS) and from cigarette smoking on insulin secretion and action in Type 2 diabetes has been compared. Twelve Type 2 diabetic smoking patients, aged 51 y, with diabetes for 9 y, treated either with diet and/or oral hypoglycaemic agents, were studied on three occasions, according to a double-blind, placebo-controlled, cross-over design. The subjects were investigated 12 h after their last cigarette or application of one patch of TNS 30 cm2 or TNS placebo, or whilst smoking their usual cigarette. Insulin secretion was assessed by a glucagon (1 mg IV) stimulation test. On a second occasion, insulin action was assessed by a hyperglycaemic-hyperinsulinaemic clamp, the spontaneous hyperglycaemia of the fasting state (8.61 mmol.l-1) being maintained during a 4 h insulin infusion (at 0.1 mU.kg-1.min-1 for the initial 2 h, and 1 mU.kg-1.min-1 during the last 2 h). TNS and the cigarette did not affect endogenous insulin secretion as compared to placebo. During the initial 2 h of the clamp study, plasma insulin increased from 88 to 155 pmol.l-1, hepatic glucose production (3-3H-glucose) was less suppressed after TNS (4.31 mumol.kg-1.min-1) than after placebo (2.5 mumol.kg-1.min-1), but was more suppressed than after cigarette smoking (5.61 mumol.kg-1.min-1). In the last 2 h of the clamp (plasma insulin 646 pmol.l-1), glucose utilization was less stimulated after TNS (36.1 mumol.kg-1.min-1) vs placebo (39.8 mumol.kg-1.min-1), but more than after cigarette smoking (33.6 mumol.kg-1.min-1), primarily because of a decrease in glucose storage.