短期胰岛素泵强化治疗对初诊2型糖尿病患者预后及胰岛β细胞功能的影响

Prognosis and islet β cell function in newly diagnosed type 2 diabetic patients treated with short-term subcutaneous insulin infusion

关键词:  2型糖尿病  胰岛素  强化治疗

Key words:  T2DM  insulin  intensive therapy

摘要:

[目的] 观察经2周短期应用胰岛素泵治疗的初诊2型糖尿病（T2DM）1年后的血糖控制情况、胰岛β细胞功能及胰岛素敏感性变化。[方法] 初诊2型糖尿病患者32例经持续皮下胰岛素输注（CSII）强化治疗2~4周后，继之分别以胰岛素、口服降糖药（OHA）、单纯生活方式控制血糖，观察1年后的血糖控制情况、胰岛β细胞功能及胰岛素敏感性的差别。[结果] CSII治疗2周期间胰岛素用量差异有显著性意义（P<0.05）；3组治疗后1年的FPG、2hPBG、HbA1c、FCP、2hCP、HOMA-β、HOMA-IR平均值各组间比较，差异无显著性意义（P>0.05）；1年后转归为：18例（56.25%）仅予生活方式干预；14例（43.75%）予OHA，无1例应用胰岛素。[结论] 对伴有明显高血糖的初诊T2DM患者应用短期CSII治疗，1年后不需再用胰岛素治疗，且多数患者不需应用任何降糖药物，仍可获得满意血糖控制，胰岛β细胞功能得到恢复。

Abstract:

[Objective] To investigate the long-term (1 year) efficacy and effects on beta-cell function and insulin sensitivity in newly diagnosed type 2 diabetic patients treated with short-term continuous subcutaneous intensive insulin therapy. [Methods] A total of thirty-two newly diagnosed type 2 diabetic patients with fasting plasma glucose (FPG) ≥11.1 mmol/L, glycoslated hemoglobin (HbA1c) ≥ 9% were enrolled. After two weeks intensive therapy of continuous subcutaneous insulin infusion and one year later, body mass index (BMI), FPG, HbA1c and 2 hour postprandial blood glucose (2hPBG), fasting C peptide (FCP) and 2 hours C peptide (2hCP) after seventy-five grams oral glucose load were recorded. Homeostasis model assessment-insulin resistance (HOMA-IR) and homeostasis model assessment-pancreatic beta-cell (HOMA-β) were calculated to evaluate insulin resistance. [Results] One year later, there is no statistical difference in the mean values of FPG and 2hPBG after 2 weeks CSII therapy. HbA1c and HOMA-IR were significantly decreased compared with those at baseline (P<0.05). FCP, 2hCP and HOMA-β after treatment were significantly higher than those at baseline (P<0.05). One year later, 56.25% patients may keep good glycemic control only rely on diet and exercise, without any agent. No patient used insulin. [Conclusion] For newly diagnosed T2DM patients with high blood glucose, short-term CSII treatment can effectively induce good glycemic control even one-year later, and significantly improve beta-cell function and insulin sensitivity. Most patients have good glycemic control without any agents or insulin.