3种短期胰岛素强化治疗初诊2型糖尿病效果比较

目的探讨3种短期胰岛素(Ins)强化治疗改善初诊2型糖尿病(T2DM)患者胰岛β细胞功能的效果。方法初诊T2DM 108例按患者自愿分为短期持续皮下胰岛素泵(CSII)组、门冬胰岛素加甘精胰岛素组(glar)、门冬胰岛素30注射液(诺和锐30)组,每组36例,分别接受不同方式的胰岛素强化治疗2周。3组治疗前后测定空腹血糖(FPG)、空腹胰岛素(F ins)、空腹C肽(FC-P)、餐后2 h血糖(2hPG)、餐后2 h胰岛素(2hIns)及餐后2 h C肽(2hC-P),计算β细胞功能指数(HOMA-β)和胰岛素抵抗指数(HOMA-IR)。结果与治疗前相比,3组治疗后FPG,2hPG,HOMA-IR均明显下降(P<0.01),F ins、FC-P、2hIns、2hC-P、HOMA-β明显升高(P<0.01)。CSII组△FC-P、△2hC-P明显高于glar组和诺和锐30组(P<0.05或P<0.01),CSII组血糖达标时间明显短于glar组和诺和锐30组(P<0.05或P<0.01),CSII组胰岛素用量明显少于glar组和诺和锐30组(P<0.05),CSII组低血糖发生频率明显低于glar组和诺和锐30组(P<0.05),而glar组和诺与税30组比较差异无统计学意义(P>0.05)。结论3种胰岛素强化治疗方案均可改善伴有高血糖的初诊2型糖尿病患者胰岛β细胞功能,减轻胰岛素抵抗,尤以CSII效果更好。

Comparison of the enhanced three short-term insulin treatments for newly-diagnosed type 2 diabetes

Objective To investigate the effects of three short-term insulins enhanced treatment for newly-diagnosed type 2 diabetes（T2DM） on improvement of the function of islet β cell.Methods One hundred and eight patients of newly-diagnosed T2DM were divided into three groups,thirty-six patients in each group.Three groups were treated with continuous subcutaneous insulin injection（CSII group）,insulin aspart plus insulin glargine（glar group）,and insulin aspart 30 injection respectively for two weeks.The levels of fasting plasma glucose（FPG）,fasting insulin（Fins）,fasting C-peptide（FC-P）,2hPG,2hIns,2hC-P were detected and homeostasis model assessments of beta cell（HOMA-β）and homeostasis model assessments of insulin resistance（HOMA-IR） were counted.Results In three groups,compare with before treatment,the levels of FPG,2hPG,HOMA-IR were descreased（P〈0.01）,and the levels of Fins,FC-P,2hIns,2hC-P,HOMA-β were increased（P〈0.01）after treatment.The △FC-P、△2hC-P of CSII group were significantly higher than glar group and insulin Aspart 30 injection group（P〈0.05,P〈0.01）,and the time of blood glucose recover of CSII group were significantly shorter than glar group and insulin Aspart 30 injection group（P〈0.05,P〈0.01）.Both insulin dosage and the incidence of hypoglycemia of CSII group were obviously less than glar group and insulin Aspart 30 injection group（P〈0.05）,but there were no significant difference between glar group and insulin Aspart 30 injection group（P〉0.05）.Conclusion The three regimes of intensive therapy for newly-diagnosed T2DM accompanied by high blood glucose may improved the function of islet β cell and eased insulin resistance,especially the CSII.