对新诊断2型糖尿病患者为期12周多次胰岛素类似物皮下注射强化治疗的疗效观察

目的 观察12周多次胰岛素类似物皮下注射强化治疗(MDI)方案对新诊断2型糖尿病患者的治疗效果。 方法 选取2013—2016年住院符合入选条件的58例初诊2型糖尿病患者，入院后采取“3短1长”(门冬胰岛素三餐前皮下注射加甘精胰岛素睡前皮下注射)的胰岛素类似物皮下注射强化方案进行治疗，并根据血糖调整胰岛素用量。住院10～14 d，患者血糖达标后(空腹血糖<7 mmol/L,餐后2 h血糖<10 mmol/L)予出院。出院后继续原方案治疗12周。观察治疗前后空腹血糖(FPG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、稳态模型评估胰岛素抵抗指数(HOMA-IR)、稳态模型胰岛β细胞功能指数(HOMA-β)、早期胰岛素分泌功能指数(△I₃₀/△G₃₀)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、收缩压、舒张压、体质量指数(BMI)及腰臀比等指标。采用配对t检验方法分析各指标变化。 结果 治疗后较治疗前FPG、FINS、HbA1c、TC、TG、LDL-C水平都有显著下降(均P<0.05)；治疗后较治疗前患者的HOME-β及△I₃₀/△G₃₀有显著上升(均P<0.05)；治疗前后收缩压、舒张压、HDL-C、HOMA-IR、BMI及腰臀比变化差异无统计学意义。 结论 对初诊的2型糖尿病患者采取为期12周的胰岛素类似物强化治疗可以良好控制血糖，显著改善胰岛β细胞功能，同时安全可靠。 

The observation on curative effect of 12 weeks intensive insulin analogues treatment for newly diagnosed type 2 diabetes patients

Objective To observe therapeutic efficacy of intensive therapy with insulin analogues on newly diagnosed type 2 diabetes. Methods We select 58 newly diagnosed type 2 diabetes patients in hospital from 2013 to 2016. ALL 58 newly diagnosed type 2 diabetic patients were treated by insulin aspart before 3 meals combined with insulin glargine at bedtime. The dosage of insulin was adjusted according to blood sugar for 12 weeks. After 10-14 days of hospitalization, the patients' blood sugar reached the standard (fasting blood sugar<7 mmol/L, postprandial blood sugar<10 mmol/L) and were discharged. After discharge, the original regimen was continued for 12 weeks. The fasting blood glucose, fasting insulin, HbA1c, HOMA-IR, HOME-β, △I₃₀/△G₃₀, TCH, TG, LDL, HDL, systolic blood pressure, diastolic blood pressure, BMI and waist to hip ratio was observed at the baseline and the end of the trail. The change of each index was analyzed by paired t-test. Results After treatment, the levels of fasting blood glucose, fasting insulin, HbA1c, TCH, TG and LDL were significantly lower than those before treatment (all P<0.05); After treatment with HOME-β and △I₃₀/△G₃₀ increased significantly than before (all P<0.05); There was no statistical significance in the changes of systolic pressure, diastolic pressure, HDL, HOMA-IR, BMI and waist to hip ratio before and after treatment. Conclusion For the newly diagnosed type 2 diabetic patients, taking 12 weeks intensive insulin analogue therapy can control blood glucose well, improve the function of β-cells, and at the same time, it is safe and reliable.