胰岛素短期强化联合增敏剂治疗初发2型糖尿病的临床研究

目的观察胰岛素强化联合胰岛素增敏剂盐酸吡格列酮治疗初发2型糖尿病（T2DM）临床疗效。方法选自我科诊治的空腹血糖（FBG）≥11.1mmol/L初发2型糖尿病患者60例,4次/d三短一中胰岛素强化治疗。4周后随机分为A组和B组,A组患者口服胰岛素增敏剂盐酸吡格列酮15mg/d,B组单纯胰岛素强化治疗,治疗8周后重新评价上述指标。采用稳态模型（HOMA）胰岛素抵抗指数（HOMA-IR）和胰岛素敏感指数（HOMA-IAI）评价研究对象的胰岛素抵抗情况;以HOMA-β评价胰岛β细胞功能。结果治疗后A组患者FBG和糖化血红蛋白水平以及HOMA-IR和HOMA-IAI改善好于B组（P〈0.05）,A组血清总胆固醇和低密度脂蛋白胆固醇改善更明显（P〈0.05）。结论早期在胰岛素强化治疗的基础上联合胰岛素增敏剂可减轻胰岛素抵抗,有助于胰岛β细胞功能保护和血糖控制。

Treatment of newly diagnosed type 2 diabetic patients with insulin intensive therapy combined with insulin sensitizer

Objective To evaluate the effect of insulin intensive therapy combined with pioglitazone, an insulin sensitizer, on newly diagnosed type 2 diabetes mellitus （T2DM）. Methods Sixty patients with newly diagnosed T2DM were treated with insulin intensive therapy for 4 weeks. Then, the patients were randomly divided into group A receiving insulin intensive therapy combined with pioglitazone （n=32） and group B receiving simple insulin intensive therapy group （n=28）. Eight weeks later, levels of glucose tolerance （OGT）, insulin, glycosylated hemoglobin Alc （HbA1c）, BP, lipid, and uric acid were measured. HOMA-IAI and HOMAIR were calculated. Results The levels of FBG, HbA1c, TG, cholesterol, LDL-C, SBP, and DBP decreased dramatically 12 weeks after treatment. FBG, HbA1c, LDL-C and cholesterol were significantly improved in group A compared with group B. The HOMAIAI and HOMA-IR were notably improved in group A compared with group B. Conclusion Insulin intensive therapy combined with pioglitazone improves T2DM by decreasing insulin tolerance, protecting the function islet β cells, and controlling blood glucose.