不同疗程胰岛素泵治疗对口服降糖药失效的糖尿病患者胰岛β细胞功能的保护作用

目的评价不同疗程持续皮下胰岛素注射（CSII）治疗对口服降糖药（OHA）治疗失效的2型糖尿病（T2DM）患者胰岛β细胞功能改善的作用。方法48例OHA治疗失败的T2DM患者按CSII疗程分成三组,7天组10例、14天组18例、28天组20例。结果14天组和28天组在疗程结束时,血糖达标的胰岛素基础用量和餐前日追加量均较治疗第一天减少;28天组平均胰岛素日用总量显著低于7天组;14和28天组第一时相胰岛素和C肽分泌显著改善;三组HbA1c均下降,以28天组最明显。P均〈0.05。1年后28天组60%单用口服降糖药即可有效控制血糖。结论CSII治疗4周更有利于OHA失效的T2DM患者胰岛β细胞功能的改善。

Comparison of a protective capacity for pancreatic β cell function between different terms of CSII treatment in diabetic patients with failure of oral hypoglycemic agents

Objective To evaluate the recovery of island β-cell function through different terms of continuous subcutaneous insulin infusion （CSII） in diabetic patients with failure of oral hypoglycemic agents （OHA）. Methods The 48 diabetic patients with OHA failure were divided into group A （10 cases, 7-day CSII）, group B （18 cases, 14-day CSII ） and group C （20 cases, 28-day CSII ）. Results Compared with group A, the daily administration of basic dose and premeal supplementary dose of insulin at targeted glucose level were decreased in group B and C （P〈0. 05 and 0. 01）. The daily administration of total dose of insulin was significantly lower in group C than in group A （P〈0. 05）. The first phase of insulin and peptide C secretion significantly improved in the group B and C versus group A （P〈0. 05 and 0. 004）. HbAlc significantly decreased in group A, B and C after CSII therapy, especially in group C （P= 0. 004）. During one year follow-up after CSII, the glucose level was controlled by OHA in 60% patients of group C. Conclusions CSII treatment for 4 weeks recovers the β-cell function better than does CSII for 1-2 weeks.