胰岛素强化治疗对成人晚发自身免疫性糖尿病患者胰岛功能的保护作用

目的　观察胰岛素强化治疗对成人晚发自身免疫性糖尿病 (LADA)患者胰岛功能的保护作用。　方法　将病程在 1年以内的LADA组患者 70例 ,随机分为胰岛素强化治疗组 (A组 )和非胰岛素治疗组 (B组 )。A组使空腹血糖 (FPG)控制在 <6 .1mmol L ,餐后 2h血糖 ( 2hPG)控制在<8mmol L ,糖化血红蛋白 (HbA1 c)控制在 <7%。B组未进行胰岛素强化治疗 ,血糖、GHbA1 c未达到A组治疗标准。二组患者随访治疗时间 6年。A、B两组完成随访观察各 32例。　结果　随病程的延长 ,酮症发生率B组高于A组 (P <0 .0 5 ) ;A、B两组在开始进入临床观察时 ,其C肽释放试验各时相值差异无显著意义 (P >0 .0 5 ) ;经 2、4、6年胰岛功能动态观察 ,2年时A组的胰岛功能比治疗前好转。随病程延长 ,B组C肽水平进行性下降 ,而A组C肽水平相对稳定 ,较B组下降明显延迟。　结论　对LADA患者及时进行胰岛素治疗可保护残存胰岛β细胞功能 ,防止糖尿病并发症的发生。

The protective effects of insulin intensive therapy on the function of islet in patients with latent autoimmune diabetes mellitus in adults

Objective To observe the effects of insulin intensive therapy on the function of islet in patients with latent autoimmune diabetes mellitus in adults(LADA). Methods 70 cases of new diagnosed LADA were randomly divided to insulin intensive therapy group(Group A) and non- insulin intensive therapy group(Group B). The treatment targets of group A were fasting plasma glucose <6.1 mmol/L, 2 h plasma glucose<8 mmol/L and HbA 1c<7%. Group B, without insulin intensive therapy, didn't achieve the target. During 6 years of follow-up treatment, 32 patients finished this clinical test in each group. Results With course progressing,the rate of diabetic ketosis was significantly higher in Group B than that in Group A. At the beginning of the clinical study, the values of C-peptide release curve were comparable in both of groups. 6 year observation of islet function showed that the islet function of Group A temporarily improved at the second year compared with the basic value, then gradually lowered following the course progress. In group B, the islet function progressively deteriorated in 6 year follow-up. Conclusion Insulin intensive therapy may protect the islet function and may prevent the development of diabetic complications in patients with latent autoimmune diabetes mellitus in adults.