胰岛素泵治疗对初诊2型糖尿病患者糖脂代谢的影响

Effects of Short-term Insulin Pump Intensive Treatment on Metabolism of Glucose and Lipid in Newly Diagnosed Type 2 Diabetic Patients

【目的】观察胰岛素泵治疗对初诊2型糖尿病患者糖脂代谢的改善作用。【方法】对空腹血糖>11.1mmol/L的85例初诊2型糖尿病患者进行为期2周的胰岛素泵强化治疗,分析比较其治疗前后血糖、糖化血红蛋白、血清胆固醇、甘油三酯及游离脂肪酸(FFA)水平。分析评价治疗前后胰岛β细胞功能和胰岛素抵抗改善情况,前者以静脉葡萄糖耐量试验(IVGTT)时胰岛素分泌第一时相、Homaβ和胰岛素原/胰岛素比值反映,后者用HomaIR表示。FFA用酶法,血浆胰岛素、胰岛素原浓度用RIA法测定。【结果】82/85患者胰岛素泵治疗次日即可见到明显的血糖下降,空腹、餐后2h血糖分别于治疗后3.45d、6.15d达到良好控制,且未见明显低血糖。治疗后血清总胆固醇、低密度脂蛋白胆固醇、甘油三酯均较治疗前明显降低,高密度脂蛋白胆固醇有明显升高,FFA则由治疗前(0.67±0.24)mmol/L下降至(0.60±0.19)mmol/L,差异具显著性。胰岛β细胞功能在治疗后获得显著改善胰岛素分泌第一时相明显增加,胰岛素曲线下面积(AUC)比治疗前有明显提高,由治疗前的每分钟(892±386)pmol/L增加至(1318±518)pmol/L(P=0.000)。Homaβ值明显提高,而胰岛素原、胰岛素原/胰岛素比值则明显下降(由30%±16%下降至17%±9%,P=0.000)。胰岛素抵抗指标HomaIR也较治疗前明显降低。【?

To evaluate the effect of short term insulin pump intensive treatment on metabolism of glucose and lipid in newly diagnosed type 2 diabetic patients with severe hyperglycemia.Eighty five newly diagnosed type 2 diabetic patients with FBG >11.1 mmol/L were treated by 2 weeks insulin pump therapy. Plasma glucose, GHbA1C, insulin, proinsulin, lipid profiles and free fatty acids (FFA) were measured and an intravenous glucose tolerance test (IVGTT) was performed before and after insulin pump treatment. The results of FBG, 2hBG, GHbA1C, lipid profiles, FFA, first phase insulin secretion, proinsulin, proinsulin/insulin ratio, Homa βand Homa IR were compared. Excellent control of FBG and 2hBG was achieved stably in 82 /85 patients in 3.45 days and 6.15 days after insulin pump therapy. The lipid profiles were obviously improved. The FFA levels were reduced remarkably from(0.67±0.24)mmol/L to (0.60±0.19)mmol/L. After 2 weeks insulin pump intensive treatment, beta cell function was dramatically improved: the first phase insulin secretion of most patients restored in different degrees. The mean area under the curve(AUC) of insulin was enhanced remarkably, (892±386) pmol/L before CSII to(1 318±518) pmol/L after CSII(P=0.000). Homa βwere significantly increased, plasma proinsulin, proinsulin/insulin ratio and Homa IR were decreased obviously. [Conclusion]Excellent glycemic control and improvement of lipid profiles and lowering of FFA along with increased beta cell function and decreased insulin resistance can be induced by short term insulin pump intensive therapy in newly diagnosed type 2 diabetic patients with severe hyperglycemia.