Can blood glucose value really be referred to as a metabolic parameter?

摘要

In clinical guidelines, near-normoglycaemia is recommended as the basic therapeutic target in diabetes mellitus. This proposal suggests that euglycaemia is associated with eumetabolism and that hyperglycaemia is an indicator of dysmetabolism. The authors analysed the relationship between short/long-term blood glucose values and cellular metabolism in various pathophysiological settings. The following types of dysmetabolism are suggested: hyperglycaemic dysmetabolism based on insulin deficiency, hyperglycaemic dysmetabolism based on glucose toxicity, euglycaemic dysmetabolism, dysmetabolism of ischaemic/reperfusional origin, and chronic stress-mediated dysmetabolism. The relationship between dysmetabolic states of various origin was also analysed. The authors conclude that the blood glucose value can only be accepted as a general metabolic parameter with marked limitations. The main arguments of this statement are that euglycaemia is not necessarily associated with eumetabolism and that acute hyperglycaemia does not necessarily indicate dysmetabolism. Identical cell metabolic performance can be supported by different biochemical energy-producing mechanisms associated with identical blood glucose values. Both positive and negative metabolic balance of cell metabolism can occur at identical blood glucose values. A further finding is that chronic hyperglycaemia acts simultaneously as a marker and as a maker of dysmetabolism; therefore, the achievement of near normoglycaemia remains the basic therapeutic goal in diabetes treatment. Insulin administration can beneficially influence dysmetabolic states of various origins. In the evolution of and interrelationships among various dysmetabolic states, the central role of chronic stress is emphasized. Discrepancies between blood glucose values and cellular metabolism are substantiated by the transporter nature of the blood glucose value; this value reflects the result of bidirectional glucose movement into and out of the tissues.