病程对2型糖尿病胰岛素强化治疗疗效的影响

Effect of Intensive Insulin Treatment in Different Disease Course Type 2 Diabetes Patients

目的研究胰岛素强化治疗对病程不同的2型糖尿病的不同影响。方法选取空腹血糖>10．0mmol／L,糖化血红蛋白>9．0%的20例2型糖尿病病人,按病程不同分为组1(初诊)和组2(病程长), 给予胰岛素强化治疗3个月。分别在开始和血糖稳定1、3个月未检测空腹血糖、胰岛素、C肽,标准馒头餐 (相当于75g葡萄糖)餐后2 h血糖和胰岛素、C肽,进行胰岛功能的比较。同时在开始和3个月结束检测糖化血红蛋白和总胆同醇、甘油三酯水平。结果两组血糖及糖化血红蛋白较治疗前显著下降,组2控制较组1差,以空腹血糖明显;组1β细胞功能(△Cp／△G)有显著性提高,而β细胞功能改变值(△Cp／△G改变值) 组1较组2明显升高;治疗结束,组1胰岛素抵抗(Homa-IR)较治疗前显著降低且与组2有显著性差异,组 1甘油三脂较治疗前显著性下降。结论胰岛素强化治疗能明显改善初诊2型糖尿病患者的糖、脂毒性,提高β细胞功能及减轻胰岛素抵抗,而对病程较长者仅一定程度改善且难以维持。

Objective To study and compare the different effects of transient intensive insulin therapy （IIT） in newly diagnosed type 2 diabetes mellitus （T2DM）and T2DM diagnosed for long course with bad glycemic control. Methods l0 newly diagnosed T2DM （group 1）and 10 T2DM diagnosed for long course with bad glycemic control （group 2） with fasting plasma glucose （FPG）≥10mmol/L and glycosylated hemoglobin Alc （HbAlc）≥9mmol/L were treated by multiple daily injection subcutaneous IIT for 3 months to compare the changes of islet βcell function. At entry and 1 month and 3 month after IIT ,blood was drawn to determine plasma glucose, insulin, C peptide at fasting and 2 hours after taking Chinese-bread meal test （equivalent to 75g of glucose） without medication. HbA1 c and total cholesteral lever（TCH） and triglyceride（TG） lever were measured before and 3 month after llT. Results （1） The FPG and the postpradial 2h plasma glucose （P2hPG） of the 2 groups were significantly lower than before（groupl）,P〈0.01,group 2,P〈0.05）, among those,the FPG of group 1 was significantly lower than that of group 2 （P〈0.01）.Accordingly,the HbA l c of the 2 groups were also significantly decreased （P〈0.01）and HbA 1 c of group 1 was lower than that of group 2 （P〈0.01）. （2） In group 1,the ratio of the postpradial C peptide （P2hCP） subtract pre-treatment C peptide（ACp）and p2hPG subtract FPG（AG） was higher than before （P〈0.01）and the difference of ACp/AG was significantly higher than that of group 2 （P〈0.01）.（3）The HOMA-IR of the group 1 was lower than before （P〈0.01） and lower than that of group 2 at the same time （P〈0.025）.（4）There were no difference in the TCH lever between the 2 groups at the end of the treatment,but the TG lever of group 1 lower than before （P〈0.05）.Conclusion The excellent glycemic and TG control and improvement of β-cell function and decreasing of HOMA-IR can be induced by multiple injection insulin therapy in newly diagnosed T2DM ,but it has little effect on T2DM having bad glycemic control for long course.