门冬胰岛素30和预混人胰岛素30R对非初发2型糖尿病胰岛功能和胰岛素敏感性的影响

Department of Endocrinology,the First Affiliated Hospital of Dalian Medical University, Dalian 116021, China

关键词:  门冬胰岛素30  预混人胰岛素30R  2型糖尿病  胰岛功能  胰岛素敏感性

Key words:  insulin aspart 30  premixed human insulin 30R  Type 2 diabetes  islet fuction  insulin sensitivity

摘要:

目的　观察门冬胰岛素30（ASP 30）和预混人胰岛素30R（PHI 30R）治疗非初发2型糖尿病（T2DM）的疗效及其对胰岛β细胞功能及胰岛素敏感性的影响，为T2DM优化治疗方案提供依据。方法　选择60例非初发的T2DM患者，随机分为两组，分别给予ASP 30和PHI 30R治疗，剂量稳定后维持治疗3个月。记录治疗前后体重指数(BMI)，测定治疗前后的空腹血糖(FPG)、馒头餐后2 h血糖（2hPBG）、糖化血红蛋白(HbA1c)、空腹C肽(FCP)及馒头餐后2 h C肽(2hCP)。计算胰岛素抵抗指数(HOMA-IR)和胰岛β细胞指数(HOMA-β)评估胰岛素敏感性和胰岛功能。结果　治疗后，ASP 30组FPG（7.28±1.65） mmol/L、2hPBG（9.39±1.31）mmol/L、HbA1c（7.18±0.97）%、HOMA-IR（0.49±0.25）均较治疗前[（9.34±3.72）mmol/L、（13.26±3.30）mmol/L、（9.22±1.95）%、（0.85±0.60）]明显下降（P<0.05）；同样PHI 30R组FPG（7.90±2.84 mmol/L）、2hPBG（10.87±2.78 mmol/L）、HbA1c（7.02±1.26）%、HOMA-IR（0.65±0.31）也较治疗前[（9.11±2.91）mmol/L、（12.58±3.23）mmol/L、（8.81±1.66）%、（0.93±0.39）]明显下降（P<0.05）；但是两组的FCP、2hCP、HOMA-β较治疗前无明显变化（P>0.05）。组间比较显示，ASP 30组治疗后的2hPBG（9.39±1.31 mmol/L）更低于PHI 30R组（10.87±2.78 mmol/L）（P<0.05），而其他指标的差异无显著性意义（P>0.05）。结论　ASP 30对餐后血糖的控制优于PHI 30R。ASP 30和PHI 30R均能明显改善非初发T2DM者胰岛素的敏感性，但ASP 30并不占优势，而二者均未能改善胰岛功能。

Abstract:

Objective 〖WTBZ〗To observe effect in non-onset type 2 diabetes mellitus (T2DM),and to provide accordance for selecting optimization of insulin therapy in patients with T2DM. 〖WTHZ〗Methods 〖WTBZ〗Sixty patients with non-onset T2DM were enrolled to this study. Blood samples were collected to test fasting blood glucose(FPG), glycosylated hemoglobin(HbA1c), fasting C-peptide (FCP), Postprandial 2-hour blood glucose (2hPBG) and postprandial 2-hour C-peptide (2hCP). Pancreatic β cell index(HOMA-β), Insulin resistance index(HOMA-IR) were calculated. After the original treatment was suspended, they were divided into two groups with twice-daily insulin aspart 30(ASP 30) or premixed human insulin 30R (PHI 30R) subcutaneous injection. It was allowed to be combined with oral hypoglycemic agents (metformin or acarbose). The treatment was proceeding at least 3 months.The indexes were measured again. 〖WTHZ〗Results 〖WTBZ〗FPG, 2hPBG, HbA1c,HOMA-IR in ASP 30 group after treatment decreased significantly compared with before treatment [(7.28±1.65) vs (9.34±3.72) mmol/L, (9.39±1.31) vs (13.26±3.30) mmol/L, (7.18±0.97) vs (9.22±1.95) %, (0.49±0.25) vs (0.85±0.60)] (P<0.05). Similarly, FPG, 2hPBG, HbA1c, HOMA-IR in PHI 30R group after treatment also decreased significantly compared with before treatment [(7.90±2.84) vs (9.11±2.91) mmol / L, (10.87±2.78) vs (12.58±3.23) mmol / L, (7.02±1.26) vs (8.81±1.66)%, (0.65±0.31) vs (0.93±0.39)] (P<0.05). But FCP, 2hCP and HOMA-β did not have markedly change after treatment in both groups compared with before treatment(P>0.05). Comparison between groups showed that 2hPBG in ASP 30 groups after treatment (9.39±1.31) mmol / L is lower than in PHI 30R group (10.87±2.78) mmol / L (P<0.05), while other indicators were no difference (P>0.05). 〖WTHZ〗Conclusion〖WTBZ〗 Compared with PHI 30R, the dominant of ASP 30 is the control in postprandial 2-hour blood glucose. The insulin resistance was significantly improve after insulin treatment, but ASP 30 is not predominant.