短期胰岛素强化治疗对2型糖尿病的疗效

目的:探讨短期胰岛素强化治疗对2型糖尿病(T2DM)的短期疗效及长期影响.方法:收集T2DM病人130例,进行2周的胰岛素泵强化治疗,随访12个月.比较治疗前后病人的空腹血糖(FPG)、2 h血糖(2hPG)、糖化血红蛋白(HbA1c)、血脂、白细胞介素6、降钙素原水平以及稳态评估法测量的胰岛素抵抗和胰岛β细胞功能,并统计随访12个月时的缓解率.结果:与治疗前比较,治疗后病人FPG、2hPG、HbA1c、白细胞介素6、降钙素原水平和胰岛素抵抗均明显下降(P<0.01),胰岛β细胞功能明显上升(P<0.01).而随访12个月时,病人FPG、2hPG 、HbA1c、总胆固醇、三酰甘油、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇亦均较治疗前明显下降(P<0.01).随访12个月时,病人总缓解率为42.31%(55/130),其中病程<3个月、3个月至1年、>1~5年、>5~10年、>10~15年以及>15年病人的缓解率分别为81.82%(18/22)、71.43%(15/21)、54.55 %(12/22)、31.82%(7/22)、13.64%(3/22)和0.00%(0/21).缓解组病人的病程明显短于未缓解组(P<0.01).结论:短期胰岛素强化治疗可保护T2DM病人胰岛β细胞功能,改善胰岛素抵抗,使病人长期获益.

Effect of short-term intensive insulin therapy on type 2 diabetes

Objective:To investigate the short-term effects and long-term influences of short-term intensive insulin therapy on type 2 diabetes mellitus(T2DM).Methods:One hundred and thirty patients with T2DM were treated with intensive insulin for 2 weeks,and followed up for 12 months.The levels of fasting plasma glucose(FPG),2 h plasma glucose(2hPG),glycosylated hemoglobin(HbA1c),blood lipid,interleukin-6(IL-6) and procalcitonin in patients between before and after treatment were compared.The insulin resistance and islet β-cell function were evaluated using homeostasis method.The alleviating rate was counted during the 12 months of following up.Results:Compared with before treatment,the levels of FPG,2hPG,HbA1c,IL-6,procalcitonin and insulin resistance significantly decreased(P<0.01),and the islet β-cell function significantly increased after treatment(P<0.01).Compared with before treatment,the levels of FPG,2hPG,HbA1c,low density lipoprotein cholesterol and high density lipoprotein cholesterol significantly decreased(P<0.01),and the total alleviating rate of patients was 42.31%(55/130) after 12 months of following up.The alleviating rate in patients with disease course <3 months,3 months to 1 year,>1 to 5 years,>5 to 10 years,>10 to 15 years and >15 years were 81.82%(18/22),71.43%(15/21),54.55 %(12/22),31.82%(7/22),13.64%(3/22) and 0.00%(0/21),respectively.The disease course in alleviating patients was significantly shorter than that in nonalleviating patients(P<0.01).Conclusions:The short-term intensive insulin therapy can protect the islet function and improve the insulin resistance of T2DM patients.