胰岛素短期强化治疗恢复磺脲类降糖药敏感性的效果分析

Short-term intensive insulin treatment and sensitivity of sulfonylureas

目的探讨胰岛素短期强化治疗恢复糖尿患者对磺脲类药物的敏感性。方法30例门诊和急诊糖尿病患者,其中男12例,女18例,均使用常规剂量磺脲类药物,但血糖控制不良。应用双相门冬胰岛素30后血糖达到控制良好3个月,之后停用胰岛素,继续以前的口服药物的治疗。结果停用口服降糖药之前3个月内平均血糖为(9.4±7.5)mmol/L,餐后2 h血糖(或随机血糖)为(14.2±7.2)mmol/L;应用胰岛素达标时的空腹血糖为(5.7±0.7)mmol/L,餐后2 h血糖为(7.2±1.4)mmol/L;应用胰岛素期间的空腹血糖为(6.0±0.8)mmol/L,餐后2 h血糖为(7.8±1.2)mmol/L;停用胰岛素时,空腹血糖为(6.1±0.6)mmol/L,餐后2 h血糖为(7.7±1.3)mmol/L。在改用原来口服降糖药后,1个月内平均空腹血糖为(6.5±0.5)mmol/L,餐后2 h血糖为(8.1±0.8)mmol/L,与应用胰岛素前相比,血糖降低的差异均有统计学意义(P<0.05)。结论短期胰岛素强化治疗有可能恢复糖尿病患者对磺脲类药物的敏感性。

Objective To research the effects of short- term intensive insulin treatment on regaining the sensitivity of sulfonylureas in diabetes patients. Methods Thirty patients from outpatient and emergency department, including 12 male and 18 female, who took regular- dose sulfonylureas but was high blood glucose level, were selected to suspend the sulfonylureas treatment and were given the BIAsp30 to control the blood glucose level for three months, then they were stopped the BIAsp30 and took the same sulfonylureas used before. Results The average fasting blood glucose （FBG） was （9.4±7.5）mmol/L and the average postprandial 2 h blood glucose （PG2h） （or random blood glucose） was （ 14.2±7.2）mmol/L in 3 months before stopping the sulfonylureas. The average FBG was （5.7±0.7） mmol/L and PG2h was （7.2±1.4）mmol/L at the beginning of the insulin getting the blood glucose under control. The average FBG was （6.0±0.8）mmol/L and PG2h was （7.8±1.2）mmol/L during the insulin treatment. The average FBG was （6.1±0.6）mmol/L and PG2 h was （7.7±1.3）mmol/L at the end of the insulin treatment. The average FBG was （6.5±0.5）mmol/L and PG2h was （8.1±0.8）mmol/L when continuing the sulfonylureas treatment in one months. It increased significantly to compare the blood glucose before the treatment of insulin to that after the treatment of insulin （P 〈 0. 05）. Conclusion Short- term intensive insulin treatment restores the patient＇s sensitiveness to sulfonylureas probably.