短期胰岛素强化治疗对不同胰岛素抵抗状态初诊 2 型糖尿病患者的疗效

目的探讨短期胰岛素强化治疗对不同胰岛素抵抗(IR)状态的初诊2型糖尿病患者的临床疗效。方法 90例初诊2型糖尿病患者按是否存在IR分为IR组(n=60)和非IR组(n=30,A组),IR组又随机分为IR胰岛素治疗组(n=30,B组)和IR联合治疗组(n=30,C组),3组均给予胰岛素强化治疗,C组在此基础上联合吡格列酮治疗,检测并分析3组疗效相关指标。结果 B、C 2组患者血糖达标时间显著长于A组,达标胰岛素日用量显著多于A组(P<0.05)。3组治疗后血糖均显著低于治疗前(P<0.05),但治疗后3组间比较差异无统计学意义(P>0.05);B组治疗2周后有4例患者血糖未达标,其余2组患者血糖均达标。3组患者治疗2周后与治疗前比较,空腹C肽、胰岛β细胞功能指数[HOMA-islet(CP)]均显著升高,IR指数[HOMA-IR(CP)]显著下降(P<0.05)。C组患者HOMA-IR(CP)、HOMA-islet(CP)的水平显著高于A组和B组(P<0.05)。结论初诊2型糖尿病患者治疗应进行胰岛β细胞功能、IR的评估,给予个体化治疗,对于存在IR的患者,在给予胰岛素强化治疗同时,应积极给予胰岛素增敏剂,以达到理想效果。

Effects of transient intensive insulin treatment on newly diagnosed type 2 diabetic mellitus in different insulin resistant status

Objective To explore the clinical effects of transient intensive insulin treatment in patients with newly diagnosed type 2 diabetic mellitus(T2DM) with different insulin resistant status.Methods A total of 90 patients with newly diagnosed T2DM were divided into insulin resistance(IR) group(n=60)and non-IR group(n=30,group A)according to the IR status.Patients in the IR group were divided into single treatment group(n=30,group B) and therapeutic alliance group(n=30,group C)randomly.Patients in the 3 groups were all treated by transient intensive insulin,and pioglitazone was added in group C.The index correlated with clinical effects were analyzed.Results Compared with group A,time for blood glucose achieving standard were significantly longer and insulin daily dose at the time were significantly higher in group B and group C(P<0.05).After treatment,blood glucose level were significantly lower than before treatment in the 3 groups(P<0.05),but there was no singnificant difference among the 3 groups(P>0.05).Blood glucose control was not achieved in 4 patients in group A,and patients in the other groups all achieved.Two weeks after treatment,fasting C peptide(FCP) and homeostasis model of assessment for islet(CP) were significantly higher but homeostasis model of assessment for IR(CP)was significantly lower than before treatment in the 3 groups(P<0.05),and the levels of HOMA-IR(CP) and HOMA-islet(CP) were higher significantly in group C than that in group A and group B(P<0.05).Conclusion The evaluation of islet β-cell function and IR should be carried out before treatment in patients with newly diagnosed T2DM.Then,individualized treatment and insulin sensitizers should be given to the patients with IR while treating with intensive insulin in order to achieve the desired result.