胰岛素短期强化治疗新诊断2型糖尿病56例临床分析

Clinical analysis for short-term insulin reinforcement treatment in 56 patients with type 2 diabetes mellitus in first visit

目的观察短期胰岛素强化治疗新诊断2型糖尿病患者的疗效。方法对56例新诊断2型糖尿病患者采用3餐前短效、睡前中效胰岛素1日4次强化治疗,2～3周使血糖控制在目标范围(FBG<7.0mmolL,2hPG<10.0mmolL)且稳定2周,分别应用饮食运动和药物(降糖药物或降糖药物联合胰岛素)治疗。比较治疗前、1年后FBG、2hPG、FINS、2hINS、HOMAβ、HOMAIR、TG、TC、BMI等指标的变化,以及1年后降糖方式与治疗时胰岛素用量、血糖达标时间、低血糖发生率。结果1年后FBG、2hPG、HOMAIR显著下降(P<0.01),2hINS、HOMAβ显著上升(分别为P<0.05和P<0.01),FINS、BMI、TG、TC差异无显著意义(P>0.05);治疗时胰岛素用量少、达标时间短的患者1年后仅饮食和运动即能控制血糖,但治疗时低血糖发生率高。结论胰岛素短期强化治疗能改善新诊断2型糖尿病患者胰岛素分泌缺陷和敏感性,为今后血糖控制奠定基础;强化治疗达到目标血糖难易程度可以预测后期血糖控制及降糖方式。

Objective To investigate the therapeutic effect of short-term insulin reinforcement treatment (SIRT)on type 2 diabetic patients in first visit.Methods Insulin reinforcement treatment was performed in 56 patients with type 2 diabetes mellitus in first visit. These patients were injected with short half-time insulin before 3 meals and mean half-time insulin before sleep.Their blood glucose (BG) had been controlled with the range of target during 2～3 weeks, which should be stable for 2 weeks,and diet,exercise as well as other oral drugs were also used respectively. The therapeutic effects of SIRT were observed.FBG,2hPG,FINS,2hINS,HOMA-β,HOMA-IR,TG,TC and BMI before treatment and 1 year after treatment were measured and compared with themselves.Results The dosage of insulin was less and effective time was shorter in short-term insulin reinforcement treatment,however,the incidence of hypoglycemia was increased.1 year later,BG of most patients were controlled by diet and exercise.FBG,2hPG and HOMA-IR decreased significantly (P<0.01),while 2hINS and HOMA-β increased significantly (P<0.01).There were no significant differences in FINS,BMI,TG and TC (P>0.05).Conclusion SIRT can improve insulin secretion insufficiency and sensitivity of insulin in patients with type 2 diabetes mellitus in first visit. The difficult and easy degree of SIRT to control BG can predict the manner of controlling and reducing blood glucose later.