胰岛素强化治疗对初诊2型糖尿病患者胰腺β细胞及血管内皮细胞功能的影响

目的探讨胰岛素强化治疗对初诊2型糖尿病(T2DM)患者胰腺β细胞及血管内皮细胞功能的影响。方法选取初诊T2DM患者196例,随机分为观察组(n=98)与对照组(n=98)。对照组给予口服降糖药治疗,观察组给予胰岛素强化治疗,即于早、中、晚餐15 min前皮下注射门冬胰岛素,睡前皮下注射甘精胰岛素,总疗程均为8周。于治疗前后观察两组患者的血糖、HbA1c和胰岛素水平,计算胰腺β细胞功能指数(Homa-β)和胰岛素抵抗指数(HomaIR),检测血清一氧化氮(NO)和内皮素(ET),超声测定内皮依赖性血管舒张功能(FMEDD)和非内皮依赖性舒张功能(NIEID)。结果治疗后,两组FBG、2hPPG、HbA1c、Homa-IR、ET水平均降低,Homa-β、NO均增高(P0.05或P0.01);且观察组FBG、2hPPG、HbA1c、Homa-IR、ET水平均低于对照组,Homa-β、NO、FMEDD高于对照组(P0.05),血糖达标时间少于对照组(P0.05)。结论短期速效胰岛素联合长效胰岛素强化治疗初诊T2DM有效控制了血糖水平,保护了胰腺β细胞及血管内皮细胞功能,对控制T2DM进展和并发症的发生具有积极的作用。

Influence on pancreatic beta cells and vascular endothelial cell function of treating newly diagnosed T2DM patients with intensive insulin therapy

Objective To explore the influence on pancreatic beta cells and vascular endothelial cell function of treating newly diagnosed T2DM patients with intensive insulin therapy. Methods 196 cases of newly diagnosed T2DM patients were selected, and randomly divided into observation group and control group, 98 cases per group. Patients in control group were given oral hypoglycemic drug, and patients in observation group were given intensive insulin treatment, giving insulin aspart 15 minutes before breakfast, lunch and dinner respectively by subcutaneous injection, and giving insulin glargine before sleep by subcutaneous injection, and they were all treatment for 8 weeks. Two groups＇ blood glucose, HbA1c, insulin levels were tested, and Homa-β and Homa-IR were calculated; serum NO and ET were observed, and FMEDD and NIEID were measured by ultrasound before and after treatment. Results After treatment,two groups＇ FBG,2hPPG,HbA1c, Homa-IR and ET levels were decreased, yet Homa- β and NO were increased （P〈0.05 or P〈0.01 ）. Observation group＇s FBG, 2hPPG, HbA1c, Homa-R and ET levels were lower than those of control group, and Homa-β, NO and FMEDD levels were higher than those of control group （P〈0.05）. Observation group＇s BG recovering time was less than that of control group （P〈0.05）. Conclusion It effectively controls blood glucose, and protects the function of pancreatic beta cells and vascular endothelial cells of treating newly diagnosed T2DM patients by short acting insulin combined with long-acting insulin intensive therapy, and it has positive role in controlling T2DM＇s progression and complications.