胰岛素强化治疗对初诊2型糖尿病患者胰岛β细胞功能的影响

The Effects of Transient Intensive Insulin Treatment on Beta-cell Function in Newly Diagnosed Type II Diabetic Patients

目的探讨短期胰岛素强化治疗对初诊2型糖尿病(T2DM)患者胰岛β细胞功能和血糖控制的影响.方法对空腹血糖>11.1 mmol/L的21例初诊T2DM患者进行为期2周的胰岛素泵(CSII)强化治疗,分析比较治疗前后空腹(FPG)及餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1 c)、静脉葡萄糖耐量试验时胰岛素分泌第一时相和胰岛素曲线下面积、胰岛素敏感指数和由Hom a模型计算的Hom aβ、Hom a IR等.结果强化治疗2周后,FPG、2 hPG、HbA1 c均较治疗前明显下降(P<0.01);空腹及第一时相胰岛素分泌、胰岛素曲线下面积和Hom aβ均较治疗前明显升高(P<0.01),胰岛素敏感指数较治疗前明显升高(P<0.05);Hom a IR也较治疗前明显降低(P<0.01).结论短期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.

Objective To study the effect of short - term intensive insulin treatment on beta - cell function and plasma glucose in newly diagnosed type 2 diabetic patients. Methods Twenty - one newly diagnosed type 2 diabetic patients with FPG 〉 11.1 mmol/L were treated by 2 weeks CSⅡ. An intravenous glucose tolerance test （IVGTY） was performed before and after CSⅡ. The levels of fasting plasma glucose （FPG）, 2 hours postprandial glucose （2 hPG）, glycosylated hemoglobin A1 c （ HbA1 c ）, first - phase secretion of insulin, the mean area under the curve （AUC） of insulin, insulin sensitivity index （ ISI）, insulin resistance index （ Homa IR） and insulin secretion index （ Homa 13） were compared. Results The excellent control of FPG and 2 hPG in 20 out of 21 patients were achieved stably in 2. 8 ± 1.6 days and 7.8 ± 1.9 days by CSⅡ. After the treatment, FPG, 2 h PG and HbA1 c were significantly decreased （ P 〈 0. 01 ） ; fasting and first - phase secretion of insulin, AUC of insulin and Homa 13 were significantly increased （P 〈 0. 01 ） ; Homa IR was also significantly decreased （P 〈 0.01 ）. Twelve patients were followed up for an average of 6 months with mean HbAlc of （5.86 ± 0. 57 ） %, FPG of （5. 8 ± 1.0） mmol/L, 2 h PG of ＊ 7.6 ± 2.2） mmol/L. Conclusion The excellent glycemic control and improvement of beta - cell function can be induced by short - term CSⅡ intensive therapy in newly diagnosed type 2 diabetic patients.