胰岛素泵短期强化治疗初诊2型糖尿病第一时相受损的临床观察

Transient insulin pump intensive treatment for newly diagnosed type 2 diabetes mellitus without first phase insulin secretion

目的探讨短期胰岛素泵持续皮下输注胰岛素(CSII)强化治疗对伴明显高血糖的初诊2型糖尿病(2-DM)患者的降糖效果和对胰岛β细胞功能的影响。方法对20例空腹血糖≥11.1mmol/L的初诊2-DM患者进行为期2周的CSII强化治疗,于治疗前后定期测定空腹血糖(FPG)、餐后2h血糖(2hPG),进行静脉葡萄糖耐量试验(IGTT),观察胰岛素分泌第一时相,计算胰岛素及C肽曲线下面积(AUC),计算胰岛β细胞功能指数(Homaβ)和胰岛素抵抗指数(Homa IR)。结果2周的CSII强化治疗后,20例患者FPG、2hPG明显下降(P<0.01),并在治疗第4.2±1.7天达到血糖控制标准。多数患者在IGTT中恢复了不同程度的胰岛素第一时相分泌,患者IGTT时胰岛素、C肽曲线下面积和Homaβ明显提高,Homa IR则明显下降(P<0.01)。结论对伴明显高血糖的初诊2-DM患者,短期CSII强化治疗具有快速稳定控制血糖和显著改善胰岛β细胞功能的作用,并能改善胰岛素抵抗。

Objective To evaluate the hypoglycemic efficacy of continuous subcutaneous insulin infusion （CSII） with transient insulin pump and its influences on beta cells in patients with newly diagnosed type 2 diabetes mellitus （2-DM） associated with hyperglycemia. Methods 20 patients with newly diagnosed 2- DM with fasting plasma glucose （FPG）≥11.1 mmol/L received CSII intensive treatment for 2 weeks. Before and after treatment,the levels of FPG and 2hPG were measured. An intravenous glucose tolerance test （IGTT） was performed. The first phase insulin secretion was observed, and the area under the curve （AUC） of insulin and C peptide were calculated.The beta cell exponents （Homa 13） and insulin resistance indexes （Homer IR） were also calculated. Results After 2-week CSII intensive treatment, decreased FPG and 2hPG were found in 20 patients （ P 〈 0.01）, and they reached to the blood glucose control standard on day 4.2 ± 1.7. During IGTT, most patients were found with different degree of first phase insulin secretion, and AUC and Homa β increased significantly, and Homer IR decreased sig- nificantly （ P 〈0.01）. Conclusion Transient CSII intensive treatment of newly diagnosed 2 - DM patients associated with hyperglycemia can rapidly and stably control the blood glucose and improve the beta cell function and insulin resistance.