Abstract
In previous reports, we demonstrated that the appearance of intestinal-type alkaline phosphatase (ALP) isoenzyme in the serum is related to the aggravation of diabetes mellitus, in addition to the genetic factors and fat intake.In the present study, the relationship between the appearance of intestinal-type ALP isoenzyme in the serum and the metabolic state of diabetes mellitus was investigated in the fasting state of patients having the same genetic factors.The total serum ALP activities and isoenzyme patterns were determined in 46 normal subjects, 170 cases of diabetes mellitus without ketosis, 15 patients with diabetic ketosis and 4 with diabetic coma, all of whom were of ABO blood group B or O and ABH secretors.Serum samples were obtained from these subjects early in the morning after a 12-hour fast.The prevalence of intestinal-type ALP isoenzyme was 28.3, 55.0, 86.7, and 100% in the normal subjects, diabetics without ketosis, diabetic ketosis and diabetic coma, respectively.These results suggest that the prevalence of intestinal-type ALP isoenzyme increases in parallel with aggravation of the metabolic state in diabetes mellitus.In fact, most of the patients with intestinal-type ALP isoenzyme were under poor control of diabetes mellitus or untreated when they were admitted.Moreover, the insulinogenic index was lower, while the fasting plasma glucose level was higher in patients having intestinal-type ALP isoenzyme than in those without intestinaltype ALP isoenzyme.Following a 2-week treatment for diabetes mellitus, the fasting plasma glucose levels of patients with diabetes mellitus having intestinal-type ALP isoenzyme were lowered to similar levels to those without intestinal-type ALP isoenzyme.Concomitant with the decline in plasma glucose levels, the total serum ALP activities were decreased and the intestinal-type ALP isoenzyme disappeared from the sera in 59 out of 104 patients having intestinal-type ALP.Thus, the prevalence of intestinal-type ALP isoenzyme in diabetes mellitus after treatment (23.8%) was similar to that in normal subjects (28.3%).
The present study demonstrates that aggravation of diabetes mellitus induces intestinal-type ALP isoenzyme in the serum, whereas normalization of the metabolic state in diabetes mellitus eliminates the intestinal-type ALP isoenzyme from the serum.
