胰岛素泵短期强化治疗初诊2型糖尿病的临床观察

The clinic observation of short-term intensive treatment of newly diagnosed type 2 diabetes by insulin pump

目的探讨初诊2型糖尿病胰岛素泵短期强化治疗对β细胞功能及其病程的影响。方法对空腹血糖>11.1mmol/L的36例初诊2型糖尿病患者进行2周的持续胰岛素皮下输注(CSⅡ)强化治疗,对比分析治疗前后血糖、胰岛素、C肽、糖化血红蛋白(HbA1c)、胰岛β细胞功能(HOMA-β)和胰岛素抵抗指数(HOMA-IR)等变化。随访患者血糖控制情况2年,分析临床缓解有关因素。结果2周的CSⅡ治疗后空腹及餐后2h血糖分别由(13.6±1.5)mmol/L、(20.1±4.0)mmol/L降至(5.6±0.4)mmol/L、(8.2±1.4) mmol/L,达到良好控制(P<0.01),且未见明显低血糖。治疗后C肽水平(1.3±0.4)μg/L,较治疗前(0.8±0.2)μg/L明显升高(P<0.05),HOMA-β(95±34),较治疗前(27±9)明显提高(P<0.02),HOMA-IR(1.26±0.29),较治疗前(2.31±0.52)明显下降(P<0.05)。随访2年,单纯饮食运动组较需加用口服药组BMI和治疗后空腹血糖低(P<0.05),血糖达标所需时间及胰岛素平均用量少(P<0.05,P<0.01)。结论胰岛素泵CSⅡ强化治疗能在短期内达到理想血糖控制,有利于胰岛β细胞功能的恢复,部分患者能够获得较长时间的临床缓解。

Objective To observe the effect of intensive insulin therapy of newly diagnosed type 2 diabetic patients on the function and course of β-cell. Methods Thirty-six newly diagnosed type 2 diabetic patients with FPG 〉 11. lmmol/L were treated by 2 weeks CSⅡ . The elements of 2 hours postprandial, insulin, C-peptide, HbAlc,HOMA-β,and HOMA-iR were analyzed and compared before and after treatment, and the control of postprandial of patients for 2 years was observed： Results The excellent control of FPG and 2h PG in 36 patients were achieved stably in （5.6 ± 0.4）mmol/L and （8.2 ± 1.4）mmol/L below the condition of （ 13.6 ± 1.5 ） mmol/L and （20.1 ±4.0）mmol/L before treatment（ P 〈 0.01 ）;the level of C-peptide highly increased to （1.3 ± 0.4）μg/L by （0.8± 0.2） μg/L before treatment（ P 〈 0.05 ） and HOMA-β was （ 95 ＋ 34 ） to （27± 9） before （ P 〈 0.02 ）, and HOMA-IR got （ 1.26±0.29） below （2.31 ± 0.52） before（P〈 0.05）. The BMI and FPG treated by symple diet were lower than those of the group taking tablets and the PG, too（P 〈 0.05, P 〈 0.01 ）. Conclusions The shortterm intensive treatment by insulin pumpCSⅡ can ideally control the PG in a short time,help to recover the function of insulin β-cell and acquire the improvement for a long time in some patients.