第一时相胰岛素分泌与2型糖尿病治疗方案的关系

目的探讨第一时相胰岛素分泌与T2DM患者治疗方案之间的关系。方法331例T2DM患者分为4组：生活方式干预组58例、非促泌剂类口服降糖药治疗组110例、促泌剂类口服降糖药治疗组70例和胰岛素治疗组93例。经过2周不同治疗方案的血糖强化控制后,测定第一时相胰岛素分泌。结果（1）组间方差分析显示,各组间年龄、糖尿病病程（中位数）、BMI、WHR、人院前平均2hPG、出院前平均2hPG、第一时相胰岛素分泌（AIR）和葡萄糖处置指数（DI）有统计学差异;（2）年龄、糖尿病病程、BMI、入院前平均FPG、入院前平均2hPG、出院前平均2hPG、LN—AIR（4．53±0．69vs4．22±0．74）和DI有统计学差异;（3）非胰岛素治疗组和胰岛素治疗组问的糖尿病病程、年龄、BMI、入院前平均FPG和2hPG以及AIR有统计学差异;（4）Logistic回归分析显示糖尿病病程、BMI和入院前平均2hPG与是否需胰岛素治疗的相关性有统计学差异（P〈O．05）。结论不同病程T2DM患者的BMI和入院前平均2hPG与是否使用胰岛素相关;AIR状态和DI不是决定治疗方案的独立因素。

The relationship between first-phase insulin secretion and the therapeutic regimen in type 2 diabetes mellitus

Objective To investigate the relationship between first-phase insulin secretion and the therapeutic regimen in T2DM. Methods The 331 T2DM patients were studied, including four groups of life-style intervention （LSI, n = 58）, non-insulinseeretagogue OHA（NIS, n= 110） insulinseeretagogue （IS,n = 70） and insulin （n = 93）. After 2-week intensive glyeemic control, the first-phase secretion of insulin was measured. Results There were significant differences in age, duration of diabetes, BMI, WHR, average 2hPG prior to hospitalization, average 2hPG prior to discharge, first phase insulin secretion [-LN（AIR）] and glucose disposition index[LN （DI）] between insulin and non-insulin therapy groups （all P〈0. 05）. （2）There were statistically significant differences in ages（47±12 vs 58± 12yr）, duration of diabetes（median： I vs 8yr）, BMI（26.1± 3.4 vs 23. 7 ± 3.3kg/m^2 ）, average FPG prior to hospitalization （8. 07±2.11 vs 8. 89±2. 33mmol/L）, average 2hPG prior to hospitalization （9.66±2.47 vs 11.58±2.91mmol/L）, average 2hPG prior to discharge （7. 80±1.12 vs 8. 58±1.39mmol/L）, first phase insulin secretion [LN（AIR）] （4.53±0.69 vs 4. 22±0. 74） and disposition index[LN（DI）] （3. 96± 0. 70 vs 3.68± 0. 64）between life-style intervention group and insulin group（all P〈0.05）; （3） There were statistically significant differences in duration of diabetes （median： 2 vs 8yr）, ages（50 ± 12 vs 58± 12yr） ,BMI（25.9±3.2 vs 23.7 ± 3.3 kg/m2）, average FPG prior to hospitalization （8. 39±1.92 vs 8. 89±2. 33mmol/L）,average 2hPG prior to hospitalization （10. 68±2. 53 vs 11.58±2. 91retool/L） and [LN（AIR）] （4. 47±0. 73 vs 4. 22 ± 0. 74） between non-insulin and insulin groups （all P〈0. 05）; （4） Logistic analysis showed that the duration of diabetes, BMI and average 2hPG prior to hospitalization were significantly and positively associated with the insulin therapy application （P〈0. 05）. Conclusions In T2