不同治疗方式对新发2型糖尿病患者胰岛β细胞功能及胰岛素抵抗的影响

目的 比较采用胰岛素治疗(INS)与口服降糖药物治疗(OHA)等不同治疗方式对新发2型糖尿病(T2DM)患者胰岛β细胞功能及胰岛素抵抗的影响,推断新发T2DM的最佳治疗方案.方法 将62例新发T2DM患者随机分为胰岛素治疗组(INS组)和口服降糖药物组(OHA组).OHA组首选磺脲类或二甲双胍,或二者合用,疗效欠佳时增加噻唑烷二酮类,一般为2药或3药合用.两组治疗期均为3个月.每组根据血糖调整剂量,目标为空腹血糖(FBG)＜6.0 mmol/L,餐后2h血糖(2hPG)＜8.0mmol/L.观察两组治疗前后FBG、2h PG、糖化血红蛋白(HbA1C)、空腹胰岛素(FINS)、空腹及餐后2hC肽(FCP、2hCP)水平的变化;用稳态模型(Homa)计算胰岛β细胞功能指数(Homaβ=20×FINS/(FBG-3.5)和胰岛素抵抗指数HomaIR=(FBG×FINS)/22.5].用治疗后CP、Homaβ、HomaIR等相关指标进行组间比较,以评价胰岛β细胞功能及外周胰岛素抵抗的变化.结果 :(1)治疗后,两组患者FBG、2hPG、HbA1C水平较治疗前均有明显下降(P＜0.01),而在两组间比较差异无统计学意义;(2)治疗后,INS组患者FINS、FCP、2hCP、Homaβ较治疗前升高(P＜0.05),OHA组则无明显变化(P＞0.05),两组间比较差异有统计学意义(P＜0.05);(3)治疗后,INS组患者HomaIR较治疗前有明显下降(P＜0.05),OHA组仅略有下降,两组间比较差异有统计学意义(P＜0.05).结论 早期应用胰岛素治疗可以改善新发T2DM患者胰岛β细胞分泌功能及外周胰岛素抵抗.与OHA相比,INS能更好地保护患者的胰岛B细胞功能.

Effect of islet β cell function and insulin resistance in patients of new-onset type 2 diabetes mellitus with different treatment

Objective To compare effect on islet β cell function and insulin resistance(IR)by insulin(INS)injection and oral hypoglycemic agent(OHA)therapy in patients of new-onset type 2 diabetes mellitus.And estimate better treatment for patients of new-onset type 2 diabetes mellitus.Methods 62 patients of new-onset type 2 diabetes mellitus were randomly divided into two groups(INS therapy group and oral OHA therapy group).In OHA therapy group,sulphonylureas(SUs)and(or)dimethyl biguanide were the first choices of drugs.Thiazolidinediones(TZDs)might be also applied in combination if the patient's blood glucose level could not reach the anticipated goal(FBG＜6.0 mmol/L and 2h PG＜8.0 mmol/L).Two or three drugs in combination were used to most of the patients.The dosage of drugs or insulin was aoljusted according to the blood glucose level.After three months of treatment,fast blood glucose(FBG),fast insulin(FINS),2-hour postchallenge glucose(2h PG),glycoslyted hemoglobin(HbA1C),fast C peptide(FCP),2-hour postprandial C peptide(2 h CP)were observed.Islet β cell function indexHomaβ=20×FINS/(FBG-3.5)]and insulin resistance indexHomaIR=(FBG×FINS)/22.5]were calculated by the homeostasis model assessment(Homa).The level of C peptide(CP)level,Homa β and Homa IR etc.of two groups after treatment were compared in order to evaluate the effect on the islet β cell function and peripheral insulin resistance.Results (1)After treatment,FBG,2 h PG,HbA1C of both groups decreased significantly(P＜0.01),there was no statistical significance between two groups.(2)Mter treatment,FINS,FCP,2h CP,Homaβ in INS therapy groups increased(P＜0.05),and these was no significantly change in OHA therapy group(P＞0.05).There was statistical significance between two groups(P＜0.05).(3)After treatment,HomaIR in INS therapy group significantly decreased(P＜0.05),and there was no significantly change in OHA therapy group(P＞0.05).There was statistical significance between two groups(P＜0.05).Conclusions Early administrated insulin therapy Can improve the islet β cell function and peripheral insulin resistance.Compared with OHA therapy,INS therapy can protect the islet β cell function preferably.