短期胰岛素强化治疗对初诊2型糖尿病患者胰岛B细胞功能的影响

目的观察强化胰岛素治疗对新诊断2型糖尿病(T2DM)患者胰岛B细胞功能的影响,并比较两种强化胰岛素治疗方案的疗效。方法将60例空腹血糖大于11.1mmol/L的初诊2型糖尿病患者分为多次皮下胰岛素注射治疗组(胰岛素注射液)和胰岛素泵组,同期选择健康体检人群30例作为健康对照组,对糖尿病患者进行2周的胰岛素强化治疗,比较强化治疗前后血糖、血三酰甘油(TG)及总胆固醇(TC)、空腹胰岛素原(FPI)、空腹胰岛素(FIns)、FPI/FIns、HomaB功能指数(HBCI)及口服馒头餐—胰岛素释放试验中糖负荷后胰岛素曲线下面积(AUCi)、AUCi/AUCg、糖负荷后30min胰岛素增值与血糖增值的比值(ΔI30'/ΔG30'),并对两个治疗组之间的上述指标进行比较。结果 (1)胰岛素注射组、胰岛素泵组两组血糖、三酰甘油、总胆固醇和糖化血红蛋白(GHbA1c)水平均明显高于健康对照驵,但两组间各指标间差异无统计学意义;(2)胰岛素强化治疗后,FIns、FIns/FBG、HBCI、AUCi和AUCi/AUCg,以及ΔI30'/ΔG30'均较治疗前显著升高(P<0.01或P<0.05),血糖、TG、TC和FPI和FPI/FIns水平较治疗前明显下降(P<0.01或P<0.05);胰岛素泵组每日所用胰岛素总量较胰岛素注射组少,患者血糖达标所需时间缩短,且胰岛素泵组反映胰岛B细胞功能的指标改善更明显(与胰岛素注射组相比,P<0.05)。结论短期胰岛素强化治可明显改善初诊2型糖尿病患者胰岛B细胞功能,胰岛素泵治疗效果相对较好。

The effect of short-term insulin intensive treatment on islet B cell function in newly-diagnosed type 2 diabetics with severe hyperglycemia

Objective To explore the effect of short-term insulin intensive treatment on islet B cell function in Newly-diagnosed Type 2 Diabetics with severe hyperglycemia and compare the different therapeutic effects between the multiple subcutaneous insulin infusion and insulin pump therapy.Methods 60 newly-diagnosed Type 2 diabetics were assigned into multiple subcutaneous insulin infusion group and insulin pump therapy group.30 people were chosen from the Medical Examination Centre of our hospital as normal control group.2 weeks intensive therapy was performed in multiple subcutaneous insulin infusion group and insulin pump therapy group.The fasting blood glucose （FBG）,triglyceride （TG）,total cholesterol （TC）,proinsulin （FPI）,insulin （FIns）,FPI/FIns,Homa B function index （HBCI） and area under the curve of insulin and AUCi/AUCg（area under the curve of glucose）,and early insulin secretion index （I30 /G30 ） were observed before and after intensive therapy.Results 1） The levels of FBG,TG,TC and GHbA1c in groups A and B were obviously higher than those in normal control group,however,the baseline of the two therapy groups had no significant difference;2） After insulin intensive therapy,FIns,FIns/FBG,HBCI,AUCi and I30 /G30 were elevated （P〈0.01 or P〈0.05）,and the BG,TG,FPI,FPI/FIns,and TC were decreased significantly（P〈0.01 or P〈0.05）.Comparing to multiple subcutaneous insulin infusion group,the daily insulin dose used in insulin pump therapy group was much lower and the indexes of islet beta cells were improved much more in insulin pump therapy group compared to multiple subcutaneous insulin infusion group （versus multiple subcutaneous insulin infusion group,P〈0.05）.Conclusions Short-term insulin intensive therapy can provide a good control of BG with the improvement of the islet beta cell function.Insulin pump therapy has superiority in lowering BG and improving the function of islet beta cells compared to multiple subcutaneous insulin infusion.