短期胰岛素强化治疗对初诊2型糖尿病患者胰岛素抵抗相关因素的影响

目的观察短期胰岛素强化治疗对新诊断2型糖尿病患者胰岛B细胞功能和炎症因子的影响,探讨强化治疗后炎症因子的变化与胰岛素抵抗改善的关系。方法对21例新诊2型糖尿病患者给予每天多次胰岛素强化治疗2周,分析比较治疗前后两次空腹血糖(FBG)、糖化血红蛋白(HbAlc)、口服75 g葡萄糖后的胰岛素的药时曲线下面积、胰岛素抵抗指数(HOMA-IR)和胰岛素分泌指数(HOMAβ)以及炎症因子的变化。结果血糖下降平稳2周后与治疗前比较,FBG、HOMA-IR、游离脂肪酸(FFA)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)的差异均有统计学意义,治疗后TNF-α下降值、FFA下降值、CRP下降值分别与治疗后HOMA-IR呈显著的正相关。结论短期胰岛素强化治疗可以明显改善初诊2型糖尿病患者胰岛B细胞功能和胰岛素抵抗,该作用可能与抑制体内炎症反应和脂毒性有关。

The analysis of relevant factors in intensive therapy to ameliorate insulin resistance in newly diagnosed type 2 diabetic patients

Objective To observe the influence of short-term intensive insulin therapy on pancreatic β-cell function in newly diagnosed type 2 diabetes（T2DM） and to explore the relationship between the changes in inflammatory cytokines and the amelioration of insulin resistance after intensive therapy.Methods A total of 21 inpatients with newly diagnosed T2DM had an intensive insulin therapy for 2 weeks.The changes of fasting blood-glucose（FBG） and HbAlc before and after the insulin therapy,the area under curve（AUC） of insulin and the changes in HOMA IR,HOMAβand inflammatory cytokines after oral glucose tolerance test were analyzed and compared.Results The FBG,HOMA-IR,serum FFA,CRP,and TNF-α decreased significantly after intensive therapy.The decrease of serum TNF-α,FFA,CRP showed significantly positive correlation with HOMA IR after the treatment with insulin.Conclusions Intensive insulin therapy can significantly improve the function of pancreatic β-cell and ameliorate insulin resistance in newly diagnosed type 2 diabetic patients.The decrease of serum FFA,CRP,TNF-α after the therapy can partly reflect the ameliorative extent of insulin resistance.