初诊2型糖尿病患者短期胰岛素强化治疗随访一年疗效分析

Follow-Up One Year after Intensification of Insulin Treatment in Newly Diagnosed Type 2 Diabetic Patients

目的探讨短期胰岛素强化治疗对初诊2型糖尿病患者血糖控制和胰岛β细胞功能恢复的效果,观察哪些患者能长期获益。方法221例初诊2型糖尿病患者给予短期胰岛素强化治疗并随访1年,在血糖控制良好的前提下观察患者治疗方案的改变,分析不同治疗方案的患者短期胰岛素强化治疗前后葡萄糖耐量试验(OGTT)和胰岛素、C肽释放试验结果。结果随访1年后,共84例(A组)患者单纯饮食、运动治疗,不需加用口服降糖药物即可将血糖控制良好;89例(B组)需加用口服降糖药物;48例(C组)需加用胰岛素。A组患者胰岛素强化治疗前的年龄和胰岛素强化治疗时间与B、C组比较,差别有统计学意义(P<0.01)。治疗前3组患者的胰岛素释放曲线和C肽释放曲线低平,高峰不明显。治疗后3组患者的胰岛素、C肽释放曲线各时点胰岛素、C肽水平明显提高,A组胰岛素、C肽水平高峰出现在服葡萄糖水后1h,在3h降低,接近空腹血糖水平;而B、C组患者的胰岛素、C肽释放高峰出现在服葡萄糖水后2h,在3h稍有下降或甚至稍有升高。3组患者治疗后AUCI、AUCC、AUCG、胰岛素抵抗指数(HO-MA-IR)及胰岛素分泌指数(HOMA-βcell)与治疗前比较,差别有统计学意义(P<0.05)。治疗前3组患者AUCC、AUCI、AUCG及HOMA-βcell间差别无统计学意义(P>0.05);而A组患者HOMA-IR与B、C组比较,差别有统计学意义(P<0.01)。治疗后3组患者HOMA-IR间差别无统计学意义(P>0.05);而A、B组AUCC、AUCI、AUCG及HOMA-βcell与C组比较,差别均有统计学意义(P<0.01)。结论短期胰岛素强化治疗能有效控制初诊2型糖尿病患者血糖,改善胰岛功能与胰岛素抵抗;年轻及短期胰岛素治疗能使患者的胰岛功能恢复更快,使患者获得长远的益处。

Objective To study the short-term and long-term impact of short-term intensive insulin treatment on glycemic control and β-cell function in newly diagnosed type 2 diabetic patients and identify the characteristics of patients with newly diagnosed type 2 diabetes who would have a long-term benefit,in terms of glycemic control,from a brief course of insulin therapy.Methods A total of 221 patients with newly diagnosed type 2 diabetes had short-term intensive insulin therapy that was then discontinued.Than they were followed-up for one year.Long-term outcome of the effect of intensive insulin treatment and its related factors were analyzed.Results The FPG,2hPG and the glucose area under curve（AUCG）of oral glucose tolerance test were significantly decreased after the treatment.One year after the short-term intensive insulin treatment the blood glucose in 84 cases that based on diet and exercise therapies was well controlled without additional oral hypoglycemic agents（group A）,whereas 89 cases should take oral hypoglycemic agents（group B）and 48 cases should use insulin（group C）.Among these three groups the patients in group A were the youngest and they need the shortest insulin treatment.In oral glucose-insulin and C-peptide release test the peak of insulin and C-peptide releasing curve in group A bring forward to half or 1 hour After intensive treatment,that in group B and C delay to 2 or 3 hour.After intensive treatment the insulin area under curve（AUCI）,the C-peptide area under curve（AUCC）and HOMA-β cell in group A and group B were not significantly different but were higher than those in group C.The HOMA-IR in group A was remarkably higher than that in group B and group C before intensive treatment but no differences were found in three groups after intensive treatment.Conclusion Insulin intensive treatment can improve blood glucose and β-cell function significantly in newly diagnosed type 2 diabetic patients.Young patients with their β-cell function recovering sooner and their peak of insulin and C-peptide releasing curve ahead to half or 1 hour in oral glucose tolerance test can acquire more long-term benefit from this treatment.