短期持续皮下胰岛素输注治疗对初诊2型糖尿病疗效的影响因素分析

目的探讨短期持续皮下胰岛素输注(CSII)治疗对初诊2型糖尿病血糖控制的影响因素。方法对138例空腹血糖>11.1mmol/L的初诊2型糖尿病患者进行2周CSII强化治疗,初始胰岛素全日量为0.5U/kg。以指尖空腹血糖(FBG)<6.1mmol/L和餐后2h血糖<8.0mmol/L为血糖控制目标,根据血糖调整胰岛素基础输注量及追加量,比较血糖控制达标组与未达标组患者临床特征、血糖水平和静脉葡萄糖耐量试验时胰岛素曲线下面积(AUC)和Homaβ等。结果经2周CSII治疗,126例(91.3%)患者用泵期间血糖控制达标,12例(8.7%)未达标。与达标组相比,未达标组治疗前FBG较高(16mmol/L±5mmol/L比13mmol/L±4mmol/L)、胰岛素β细胞分泌指数(Homaβ)值较低(17±10比36±25),ΔAUC(治疗后AUC-治疗前AUC)较低,治疗期胰岛素用量较大。结论更严重的高血糖和胰岛β细胞功能低下可能是初诊2型糖尿病患者短期CSII强化治疗血糖控制欠佳的主要原因。

Influencing factors for the curative effects of short-term continuous subcutaneous insulin infusion on newly diagnosed type 2 diabetes

OBJECTIVE: To investigate the effects of short-term continuous subcutaneous insulin infusion (CSII) on newly diagnosed type 2 diabetes and to identify the influencing factors for the curative effects of CSII. METHODS: 138 newly diagnosed type 2 diabetic patients with fasting plasma glucose > 11.1 mmol/L were treated with CSII for 2 weeks. Intravenous glucose tolerance test (IVGTT) was performed before and after CSII. The target of glycemic control were fasting blood glucose < 6.1 mmol/L and postprandial blood glucose (PBG) < 8.0 mmol/L. The age, body mass index (BMI), fasting and postprandial plasma glucose, hemoglobin A(1C) (GHbA(1C)), Homa beta, Homa IR, area under the curve of insulin (AUC) during IVGTT were compared between the good glycemic control group and the inadequate glycemic control group. RESULTS: After 2 weeks' CSII treatment, good glycemic control was achieved in 126 patients (group A) but not in the remaining 12 patients (group B). There were no differences in age, BMI, postprandial plasma glucose, GHbA(1C), and Homa IR between the two groups before and after CSII treatment. But the fasting plasma glucose was higher and Homa B was lower in group B than in group A before CSII treatment. The DeltaAUC (AUC after CSII subtracted from that before CSII) representing the recovery of beta-cell function was much greater in group A than in group B. The insulin dose of group B was significantly higher than that of the good glycemic control group. CONCLUSION: More severe hyperglycemia and relative beta-cell function deficiency may be the main reasons responsible for not achieving good glycemic control in newly diagnosed type 2 diabetic patients with short-term intensive CSII treatment.