两种胰岛素强化疗法对2型糖尿病人胰岛功能改善的比较

Effects of two regimes of intensive insulin therapy for type 2 diabetes on improvement of the function of islet b cell

目的比较胰岛素泵连续皮下输注(CSII)和多次皮下注射治疗(MSII)对初发2型糖尿病人胰岛功能改善的效果。方法新诊断的2型糖尿病患者64人,分为MSII组(26例)和CSII组(38例),其中MSII组中女性14例,男性12例,CSII组中女性18例,男性20例,CSII和MSII两组的年龄、空腹C肽、空腹血糖、BMI、HbA1c差异无显著性意义(P>0.05)。患者入院后行胰岛素强化治疗,帮助胰岛细胞功能恢复。治疗的目标血糖值为三餐前血糖在3.6～6mmol/L之间。达到目标血糖值后全天胰岛素的总剂量小于30U,则停用胰岛素,改为口服降糖药物;若全天胰岛素的剂量仍大于30U,则继续胰岛素强化治疗。观察1个月后,比较两组病人改为口服降糖药物的比例。结果胰岛素强化治疗1月后两组中停用胰岛素,改为口服降糖药物的患者:CSII组为81.5%(31/38),其中10例已经完全停用磺脲类药物;MSII组为30.8%(8/26),差异有显著性意义(P<0.05)。治疗后的CSII组餐后2hC肽较MSII组明显增高,两组间比较差异有显著性意义(P<0.05)。结论2型糖尿病发病与胰岛素抵抗和胰岛细胞功能受损有关,在初诊断的2型糖尿病患者中,胰岛素强化治疗可迅速恢复细胞功能。胰岛素泵强化治疗可使更多的初诊2型糖尿病人改为口服用药,且血糖仍控制良好。

Objective To investigate the effect of continuous subcutaneous insulin injection （CSII） and multiple subcutaneous insulin injection （MSII） on islet b cell function at the onset of type 2 diabetes. Method 64 patients were randomly divided into CSII （f/m=18/ 20） and MSII groups （f/m= 14/12）. There was no significant difference in age, fasting C peptide level, fasting blood glucose level, BMI and HbAlc. The patiems of both groups were given imensive insulin therapy. Once the total dosage of daily insulin was kept less than 30U and the fast blood glucose was 3. 6- 6. 0 mmol/L, imensive insulin therapy was changed to oral administration of hypoglycin A （OHA）, otherwise the intensive insulin therapy was continued. The number of patients who were switched over to oral drug was compared after one month after the intensive therapy. Result 31 patients in CSII group and 8 patients in MSII group were changed to OHA one month after intensive therapy. A significant difference existed between the two groups （Х^2 =3. 37, P〈0. 05）. The level of postprandial plasma C peptide in CASIIgroup was higher than that in MSII group after intensive therapy （ P〈0. 05）. Conclusion The insulin resistance and injury of islet b cell function may induce the type 2 diabetes. Intensive insulin therapy may ameliorate insulin resistance and recover the islet b cell function.