The glucose homeostasis system ensures that the circulating glucose level is maintained within narrow physiological limits both in the fasting (or basal) state and following a nutrient challenge. Although glucose homeostasis is traditionally conceptualized as a single overarching system, evidence reviewed here suggests that basal glycemia and glucose tolerance are governed by distinct control systems. Specifically, whereas glucose tolerance appears to be determined largely by interactions between insulin secretion and insulin sensitivity, basal-state glucose homeostasis is predominated by insulin-independent mechanisms governed largely by the brain. In addition to a new perspective on how glucose homeostasis is achieved, this “dual control system” hypothesis offers a feasible and testable explanation for observations that are otherwise difficult to reconcile and sheds new light on the integration of central and peripheral metabolic control mechanisms. The implications of this model for the pathogenesis and treatment of impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes are also discussed.

中文翻译：

---

大脑和胰腺在基础和餐后血糖稳态中的不同作用


葡萄糖稳态系统确保在禁食（或基础）状态和营养挑战后，循环葡萄糖水平维持在狭窄的生理限度内。尽管葡萄糖稳态传统上被概念化为一个单一的总体系统，但这里回顾的证据表明基础血糖和葡萄糖耐量是由不同的控制系统控制的。具体来说，虽然葡萄糖耐量似乎主要由胰岛素分泌和胰岛素敏感性之间的相互作用决定，但基础状态葡萄糖稳态主要由主要由大脑控制的胰岛素依赖性机制主导。除了如何实现葡萄糖稳态的新视角之外，这种“双重控制系统”假说还为难以协调的观察结果提供了可行且可测试的解释，并为中枢和外周代谢控制机制的整合提供了新的线索。还讨论了该模型对空腹血糖受损、糖耐量受损和 2 型糖尿病的发病机制和治疗的影响。