初诊2型糖尿病患者短期胰岛素强化治疗后胰岛β细胞功能的变化和疗效观察

Changes of β-cell Function after Short-term Transient Intensive Insulin Treatment in Newly Diagnosed Type 2 Diabetes Patients

观察胰岛素短期强化治疗对明显高血糖的初诊2型糖尿病(2DM)患者的胰岛β细胞功能的影响。对空腹血糖>12.0mmol/L的24例初诊DM患者进行胰岛素强化治疗,分析比较治疗前后和两次随访的空腹血糖、糖化血红蛋白(HbA1c)、口服75g葡萄糖后的胰岛素及释放曲线面积和由HOMA模型计算的HOMA IR和HOMAβ。血浆胰岛素用放射免疫分析法测定。平均9.0±4.8天的胰岛素强化治疗后,患者的血糖、HbA1c较治疗前明显降低(P<0.01);胰岛素、胰岛素释放曲线下面积和HOMAβ较治疗前明显提高(P<0.01),而HO-MA IR明显降低(P<0.01)。其中随访的13例患者中,6个月和12个月后随访平均空腹血糖分别为6.28±0.75mmol/L和6.62±1.19mmol/L;餐后2h血糖分别为8.72±1.66mmol/L和10.03±4.49mmol/L;HbA1c分别为5.98%±0.72%和7.12%±1.81%;空腹胰岛素分别为10.67±5.08μIU/L和7.85±1.82μIU/L;HO-MA IR分别为2.88±1.22和2.36±0.93;HOMAβ分别为90.01±61.29和56.9±25.4。仅采用饮食控制和体育锻炼,其中8例(8/13)获得长达一年的良好的血糖控制。明显高血糖的2DM患者,短期胰岛素强化治疗具有快速控制血糖和显著改善胰岛β细胞功能的作用。

To evaluate the effect of short-term intensive insulin treatment on β-cell function in newly diagnosed type 2 diabetes patients with apparently hyperglycemia, twenty-four newly diagnosed type 2 diabetes patients with FPG more than 12.0 mmol/L were treated by short-term transient intensive insulin in average 9.0±4.8 days. Their β-cell function was assessed by oral glucose tolerance test. The FPG, HbAlc and HOMA IR of patients were significantly decreased （P〈0.01）, while the insulin, the Area Under Curve （AUC） of insulin and HOMA β were significantly increased （P〈0.01） after the treatment with insulin. Improvement of β-cell function can be induced by short-term intensive insulin treatment for newly diagnosed type 2 diabetes patients with apparently hyperglycemia.