胰岛素强化治疗疗程对初诊2型糖尿病患者影响的临床研究

目的观察不同疗程的胰岛素强化治疗对初诊2型糖尿病（T2DM）患者胰岛β细胞功能的长期影响，探讨胰岛素强化治疗的最佳疗程。方法按胰岛素强化疗程，将初诊2型糖尿病患者120例随机分为15、30、60、90d4组，检测治疗前后及治疗结束1年、2年后胰岛β细胞功能，比较各组的差异。结果4组患者治疗后血糖均良好控制，胰岛β细胞功能显著改善，30、60及90d3组在治疗后AI30／AG30较15d组高[（1．48±0．43）mmoL／LVS（1．25±0．40）mmol／L，t=2．40，P〈0．05；（1．83±0．37）mmol／LVS（1．25±0．40）mmol／L，t=2．85，P〈0．0l；（1．90±0．41）mmol／LVS（1．25±0．40）mmol／L，t=2．97，P〈0．01]。治疗结束2年后，各组胰岛β细胞分泌功能指标均逐渐下降，但均高于治疗前水平（P〈0．05）；60d组及90d组A130／AG30高于15d及30d组[（1．44±0．51）mmot／LVS（0．87±0．47）mmol／L，t=2．92，P〈0．01，（1．44±0．51）mmol／LVS（1．09±0．55）mrnoL／I．，t=2．44，P〈0．05，（1．52±0．44）mmol／LVS（0．87±0．47）mmol／L，t=2．86，P〈0．01，（1．52±0．44）mmol／LVS（1．094-0．55）mmol／L，t=2．50，P〈0．05]，90d组同60d组比差异无统计学意义（P〉0．05）；60d及90d组缓解率较高。结论胰岛素强化治疗可为初诊T2DM患者带来长期缓解，适当延长疗程可更能延缓胰岛β细胞功能的下降。

Clinical analysis of intensive insulin treatment course in newly diagnosed type 2 diabetic patients

Objective To investigate the effect of intensive insulin therapy on long-term remittance of the islet β-cell function in newly diagnosed type 2 diabetic patients. Methods 120 newly diagnosed type 2 diabetic patients were randomly divided into four groups, and intensive insulin therapy was given for 15 days, 30 days, 60 days and 90 days respectively. The islet β-cell function were measured before and 1 or 2 years after treatment, and the differences were compared among each group. Results The plasma glucose was controlled well and the islet β-cell function was significantly improved in each group after treatment. The ratio value of △I30/△G30 in groups of 30 days,60 days and 90 days were higher than group of 15 days[(1.48±0.43 )mmol/L vs (1.25±0.40) mmol/L, t＝2.40,P＜0.05, (1.83±0.37) mmol/L vs (1.25±0.40) mmol/L, t＝2.85,P＜0.01, (1.90±0.41) mmol/L vs (1.25±0.40) mmol/L, t＝2.97,P＜0.01]. The indexes of the islet β-cell secretion function all gradually declined in each group after treatment for 2 years, but still higher than before treatment, the ratio value of △I30/△G30 in groups of 60 days and 90 days were higher than group of 15 days and 30 days[(1.44±0.51)mmol/L vs (0.87±0.47) mmol/L,t＝2.92, P＜0.01, (1.44±0.51)mmol/L vs (1.09±0.55) mmol/L, t＝2.44,P＜0.05, (1.52±0.44) mmol/L vs (0.87±0.47) mmol/L, t＝2.86, P＜0.01, (1.52±0.44) mmol/L vs (1.09±0.55) mmol/L, t＝2.50, P＜0.05], there was no difference between group of 60 days and 90 days. The ratio of remittance in groups of 60 days and 90 days was very high. Conclusions Intensive insulin therapy can significantly improve the islet β-cell function of newly diagnosed type 2 diabetic patients,anddelay the natural process. An appropriate extension of treatment can further prevent the descending rate of islet β-cell function, and easily get the long-term remission.