早期强化治疗对不同血糖水平新诊断2型糖尿病患者胰岛β细胞功能和预后的影响

目的 评价早期强化治疗对不同血糖水平新诊断2型糖尿病患者胰岛β细胞功能和预后的影响.方法 382例新诊断2型糖尿病患者随机给予持续皮下胰岛素输注(CSII)、每日多次胰岛素注射(MDI)及口服降糖药(OHA)短期强化治疗,治疗前后测血糖、血脂及游离脂肪酸(FFA)、空腹胰岛素原与空腹胰岛素比值(PI/I),行静脉葡萄糖耐量试验(IVGTT),评价胰岛素急性分泌时相(AIR),计算稳态模型母细胞功能指数(HOMA-β)和胰岛素抵抗指数(HOMA-IR).随访1年以上.根据入选时空腹血浆血糖(FPG)水平进行分层分析,A层:7.0 mmol/L≤FPG<11.1 mmol/L,B层:11.1 mmol/L≤ FPG≤16.7 mmol/L.结果 A层患者的治疗达标率更高(94.4%比89.8%),血糖达标时间更短,1年缓解率也更高(47.8%比35.7%,P<0.05);而B层患者治疗后血糖、血脂的改善和FFA的下降更明显,且HOMA-β增加更多,但A、B层患者间AIR、PI/I比值和HOMA-IR改善程度差异无统计学意义.而无论A层或B层,胰岛素治疗(CSII、MDI)较OHA组有更高的1年缓解率(A层:57.1%,51.8%比32.8%,P<0.05;B层:44.4%,38.7%比18.6%,P<0.05).结论 短期胰岛素强化治疗较口服药治疗不仅使FPG较高的2型糖尿病患者具有更高的1年缓解率,在FPG轻中度增高的患者中获益也较大.

The effects of early intensive therapy on islet beta cell function and long-term glycemia control in newly diagnosed type 2 diabetic patients with different fasting plasma glucose levels

Objective To investigate the effects of early intensive therapy on P cell function and long-term glycemic control in newly diagnosed type 2 diabetic patients with different recruiting fasting plasma glucose (FPG) levels.Methods A total of 382 newly diagnosed type 2 diabetic patients with FPG 7.0-16.7 mmol/L were randomly assigned to therapy with insulin in the form of continuous subcutaneous insulin infusion (CSII) or multiple daily injection (MDI) or oral hypoglycemic agents (OHA, by using gliclazide and/or metformin) for initial rapid correction of hyperglycemia.The treatments were stopped after euglycemia had been maintained for 2 weeks.The patients were followed longitudinally on diet alone for 1 year.Intravenous glucose tolerances tests (IVCTTs) were performed and blood glucose, insulin and proinsulin were measured before and after therapy as well as at 1-year follow-up.Homeostasis model assessment ( HOMA) of β cell function and insulin resistance index ( HOMA-β and HOMA-IR ) were calculated.All the patients were stratified on the recruiting FPG: stratum A (7.0 mmol/L≤ FPG < 11.1 mmol/L) , stratum B (11.1 mmol/L≤ FPG ≤ 16.7 mmol/L).Results More patients in stratum A achieved target glycemic control (94.4% vs 89.8% ) and in shorter time (5.9 ±3.8)d vs(6.9 ±3.6)d, P <0.05] as compared with those in stratum B.B cell function represented by HOMA-β and acute insulin response ( AIR) improved significantly after intensive interventions in both stratum A and B patients.However, the remission rate at 1 year was significantly higher in stratum A patients (47.8% ) than those in stratum B (35.7%, P < 0.05).The patients treated with insulin (especially with CSII) had higher remission rates and better improvement of AIR at 1 year follow-up irrespective of the recruiting FPG (CSII or MDI vs OHA: 57.1% , 51.8% vs 32.8% in stratum A, P <0.05; 44.4% , 38.7% vs 18.6% in stratum B, P <0.05).Conclusions Compared with OHA, early short time intensive insulin treatment had more favorable outcomes on maintaining AIR and prolonged glycemic remission in newly diagnosed type 2 diabetic patients irrespective of the recruiting FPG levels.