胰岛素强化治疗对初诊2型糖尿病人胰岛β细胞功能的影响

目的探讨短期胰岛素强化治疗对伴有明显高血糖的初诊2型糖尿病患者的降糖效果及其对胰岛β细胞功能的影响,并比较胰岛素泵持续输注法(CSII)和多次皮下注射法(MSII)的疗效差异。方法68例初诊2型糖尿病患者分为CSII组和MSII组,治疗过程分为对照期、调量期和稳定期,设定靶血糖值FBG<6.1mmol/L,2hPG<8.3mmol/L,测定治疗前及稳定期2周后空腹及餐后2h血糖和空腹胰岛素,按稳态模型计算胰岛β细胞功能(HOMA-β)和胰岛素抵抗指数(HOMA-IR),观察两种强化治疗方法的降糖效果及对胰岛β细胞功能影响。结果两组患者对照期、调量期和稳定期空腹及餐后2h血糖比较,差异均无显著性(P>0.05);两组治疗后HOMA-β均较治疗前增高,HOMA-IR均较治疗前降低,差异有显著性(P<0.05);两组间治疗前后HOMA-β和HOMA-IR差异无统计学意义(P>0.05),CSⅡ组胰岛素用量较小,低血糖发生率低,达标时间较早。结论短期胰岛素强化治疗能改善胰岛β细胞功能,减轻胰岛素抵抗。CSII较MSII更适合于强化治疗。

Objectives To explore the short - term insulin＇ s intensified therapeutic effect on beta cells of islet and curing effect in patients with type 2 diabetes mellitus（DM） at preliminary diagnosis, the difference of the curative effect of continuous subcutaneous Insulin - Pumpentherapie （CSII）and multi - times subcutaneous injection （MSII）. Methods 68 patients with type 2 diabetes mellitus（DM） at preliminary diagnosis were divided into CSII group （36 patients ） and MSII group（32 patients ）, the treating procedure was divided into control stage , regulatory stage and stabe stage , the target BG value was fasting blood sugar （FBG） 〈 6.1 mmol/L, 2h postprandial blood glucose （2hPG） 〈 8.3mmol/L, protherapy and 2 weeks after stabling phase , FBG and 2hPG and fasting blood insulin were tested . Function of beta cells of islet （ HOMA - β）and insulin resistance index （ HOMA - IR）were accessed with steady model , the curative effect and influence on function of beta cells of islet of the two intensification therapy were observed . Results There was no significant difference in FBG and 2hPG between the two groups in control stage , regulatory stage and stable stage （ P 〉 0. 05） ; HOMA - βincreased and HOMA - IR decreased after treatment in both groups , the difference is significant （ P 〈 0. 05 ） ; the difference of the change of HOMA - βHOMA - IR before and after treatment in the two groups was of no statistic significance（ P 〉 0.05） . But in CSII group , the insulin used was less , the incidence rate of glycopenia was lower and the time to achieve the target BG was earlier . Conclusion Short - term Insulin＇ s intensified therapy could improve the function of beta cells of islet and relieve insulin resistance. Compared with MSII, CSII was more applicable for intensification therapy .