初诊肥胖2型糖尿病患者短期胰岛素强化治疗的临床研究

目的 研究初诊肥胖2型糖尿病(DM)患者短期胰岛素强化治疗后胰岛β细胞功能变化，探求更好的血糖控制达标方案。方法 将空腹血糖≥11.1mmol／L和(或)餐后2小时血糖≥16mmol／L的120例初诊肥胖2型DM患者分为三组，其中合并酮症19例作为A组，其余随机分为B组和C组(对照组)。A、B组采用胰岛素强化治疗后同C组一样进入研究，观察随访2年时三组血糖达标后胰岛β细胞功能变化和治疗方案。结果 随访2年时，三组间胰岛素分泌指数(HOMA-IS)有显著性差异，C组与A、B组和自身1年时比较HOMA-IS显著降低，但与初诊时无显著性差异，A、B组满1年时仍保持胰岛素分泌功能。A组和B组以食疗和运动疗法以及加二甲双胍治疗为主占78．2％；C组68．6％的患者需加磺脲类药物治疗，11．8％需要胰岛素治疗。结论 2型DM患者经短期胰岛素强化治疗后，对恢复和保持胰岛β细胞功能起到一定作用，2年内多数患者以基础治疗和二甲双胍治疗为丰。

Study of pancreatic beta-cell function of newly diagnosed obese patients with typc 2 diabetes

Objective To study the changes of pancreatic beta-cell function following-up 2 years after short-term intensive treatment with insulin in newly diagnosed obese patients with type 2 diabetes, and search for better steps to the targets of blood-glucose control.Methods We chose 120 patients, which fasting blood glucose was above 11.1 mmol/L and/or postprandial blood glucose was above 16.0 mmol/L. 19 case of patients companied with ketoacidosis were in A group, others were randomly distributed to B and C group(control group). When blood glucose of patients in A and B group got to the targets after insulin intensive therapy, they entered into our study as the same as patients in C group.Results At the end of 2 years, their HOMA-IS appeared significant difference between A and C group, B and C group,but no significant difference between A and B group. HOMA-IS of C group was significant lower than that of A and B group, and of C group itself at the end of the following-up 1 year, but no significant difference compared with themselves at the time of being diagnosed. Patients in A and B group mainly treated with dietary and exercising therapies and taking metformin, but there were 68.6% patients needing sulfonylureas and 11.8% patients needing insulin in C group. Conclusion These results indicated that short-term intensive therapy with insulin had important effects on turnning over and maitaining beta-cell function for obese patients with type 2 diabetes. After insulin intensive therapy, most obese patients arrived at good control mainly relying on fundamental therapies and metformin.