短期胰岛素泵强化治疗新诊断2型糖尿病的疗效观察

目的比较胰岛素泵与多次皮下注射胰岛素类似物2种方法治疗对新诊断2型糖尿病患者血糖及胰岛B细胞功能的影响。方法选择新诊断住院2型糖尿病患者62例，随机分为2组，每组31例，一组使用胰岛素泵持续皮下注射门冬胰岛素治疗（CSII），另一组予三餐前门冬胰岛素加睡前地特胰岛素皮下注射治疗（MDI），治疗2周，随后门诊口服药物治疗6个月，比较2组的空腹血糖、餐后血糖、空腹血清C．肽、餐后2h血清c-肽、HbAlc及低血糖发生率。结果2组患者住院治疗后空腹及餐后血糖均显著下降（P〈0．01），2组空腹血清c．肽、餐后2h血清C．肽均明显升高（P〈0．01），CSII组血糖达标时间较MDI组短（P〈0．05）。CSII组低血糖发生率（0．161次／人）低于MDI组（0．387次／人）（P〈0．05）。门诊治疗6月后，CSII组的HbAlc下降值较MDI组显著，未服口服降糖药血糖达标率较高（P〈0．05）；CSII组的血清空腹c-肽及餐后2hc一肽增加较MDI组显著。结论2组注射方法均能使血糖获得良好控制，使用胰岛素泵能尽快使血糖达标，低血糖发生较少，中长期血糖控制及胰岛B细胞功能保护更佳。

Effect of Short-Term Intensive Diagnosed Type Insulin Pump Treatment in Newly 2 Diabetic Patients

Objective To study the impact of short-term intensive insulin pump treatment on 13-cell function and long- term glycemic control in newly diagnosed type 2 diabetic patients. Methods A total of 62 newly diagnosed type 2 diabetic hospitalized patients were treated with continuous subcutaneous insulin analogue （aspart） infusion group （ CSII, n =31） or multiple daily injection group （aspart and detemir） （MDI, n = 31 ） for 2 weeks, and then all patients were treated by oral hypoglycemic drugs for 6 months in outpatient. The level of fasting and post prandial blood glucose, fasting and 2 h postprandial serum C-peptide, HbAlc of the patients, and the incidence of hypoglycemia in all patients were assessed and compared. Results After hospitalization, the levels of fasting and 2 h postprandial blood glucose of patients in both group were significantly decreased （P〈O.05）, the levels of fasting serum C-peptide and 2 h postprandial serum C- peptide were significantly increased （P〈0.05）. Compared with MDI group, the time when the blood glucose was under ideal control in CSII group was shorter （P〈O.05）, and the incidence of hypoglycemia in patients of CSII group was less （P〈0.05）. After treated for 6 months in outpatient department, the decrease of HbAlc in patients of CSII group was higher than that in MDI group. The patients whose glucose was under ideal control without any drugs was more in CSII group than that in MDI group. The increase of serum fasting C-peptide and 2 h postprandial C-peptide in CSII group were higher than those in MDI group. Conclusion Although blood glucose was under good control with both the two treatment methods, it is indicated that blood glucose achieved to the desired goals faster, having less hypoglycemia, longer-term good blood glucose control and better protection of B-cell function by using short-term insulin pump therapy.