两种胰岛素强化治疗方案对初诊2型糖尿病患者胰腺β细胞功能的影响

Effect of two intensive insulin treatments on beta-cell function in newly diagnosed type 2 diabetic patients

目的观察两种胰岛素强化治疗方法,对初诊2型糖尿病患者的血糖控制和胰腺β细胞功能的影响。方法28例初诊2型糖尿病患者随机分为胰岛素泵组及多次胰岛素注射组,强化治疗2周,测定每组治疗前后空腹血糖(FPG)及餐后2小时血糖(2hPG),糖化血红蛋白(HbA1c),口服葡萄糖耐量试验(OGTT)0分钟及120分钟胰岛素、C肽,胰岛素分泌指数(Homaβ),胰岛素抵抗指数(HomaIR),糖负荷后胰岛素曲线下面积(AUCi)等参数。结果两组均显示出明显的降糖效果,治疗后OGTT120分钟胰岛素、C肽,Homaβ及AUCi较治疗前均明显增加,其差异有统计学意义(P<0.001),HomaIR明显下降(P<0.001);两组间比较,除血糖达标时间及达标时胰岛素用量的差异有统计学意义(P<0.05)外,同期的FPG,2hPG,HbA1C,OGTT0分钟和120分钟胰岛素、C-肽,Homa-β,HomaIR及AUCi等值差异均无统计学意义(P>0.05)。结论对初诊2型糖尿病患者,胰岛素泵治疗和多次胰岛素注射治疗均能达到快速稳定控制血糖并可显著改善胰腺β细胞功能的目的,但胰岛素泵治疗可以使血糖得到更快的控制。

Objective To study the impact of two methods of inten sive insulin treatments on plasma glucose and beta-cell function in newly diagn osed type 2 diabetic patients. Methods Twenty-eight newly diagnosed type 2 diabetic patients w ere divided into two groups randomly. They were treated respectively for two wee ks by continuous subcutaneous insulin infusion(CSII) and several times of insuli n infusion. Fasting plasma glucose(FPG),2 hour postprandial glucose( 2 hPG), glycosylated hemoglobin A 1c(HbA 1c) were tested before and after treatment in two groups; 75-g oral glucose tolerance test(OGTT) 0 minute and 120 minute ins ulin,C-peptide,insulin secretion index(Homa β),insulin resistance index(Homa I R) and the mean area under the curve of insulin(AUCi) were measured and compared before and after treatment in two groups. Results The excellent control of glucose was achieved in both gro ups. OGTT 120 minute insulin,C-peptide,Homa β and AUCi were increased signifi cantly after treatments(P< 0.001), Homa IR was decreased evidently(P< 0.001). The homeochronous parameters for FPG, 2 hPG, HbA 1c,OGTT 0 m inute and 120 minute insulin,C peptide,Homa β,Homa IR,AUCi had no significan t difference(P> 0.05) except the time and the insulin dosage of glucose u p to scratch (P< 0.05). Conclusion The CSII and several times insulin infusion treatments can equally achieve the excellent glycemic control and improvement of beta-cell function in newly diagnosed type 2 diabetic patients. But CSII group could rece ive faster control on blood glucose than several times of insulin infusion group .