短期应用胰岛素泵强化治疗初发2型糖尿病随访1年疗效观察

Effects of short-term continuous subcutaneous insulin infusion intensive treatment in newly diagnosed type 2 diabetic patients:a one-year follow-up study

目的:观察短期应用胰岛素泵输注胰岛素(CSII)治疗的初发2型糖尿病患者1年的胰岛β细胞功能的变化。方法:26例空腹血糖>11.1 mmol/L的初发2型糖尿病患者进行2周的CSII强化治疗并随访1年,对治疗前、治疗后不同时期的FBG,2hBG,HbA1c,胰岛β细胞功能Homa-β及胰岛素抵抗指数Homa-IR的变化进行评估。结果:CSII强化治疗2周后,26例患者的FBG、2hBG、HbA1c水平较治疗前显著下降(P<0.001);Homa-IR较治疗前下降(P<0.05),Homa-β较治疗前增高(P<0.01)。随访至12个月时仍有17人(65.38%)维持单纯饮食和运动治疗达良好血糖控制,其Homa-IR及Homa-β与停泵时比较无变化,另有9人(34.62%)血糖控制不佳,比较发现此组患者入选时HbA1c水平、治疗后血糖达标天数及达标时胰岛素用量均较高(P<0.05)。结论:对伴有明显高血糖的初发2型糖尿病患者,短期应用胰岛素泵持续皮下输注胰岛素能改善和/或恢复胰岛β细胞功能,重建饮食和运动治疗对血糖的反应性。

Objective： To observe the effects of short-term continuous subcutaneous insulin infusion （CSII） intensive treatment on plasma glucose and β-cell function in newly diagnosed type 2 diabetic patients followed up 1 year. Methods： 26 newly diagnosed type 2 diabetic patients with FPG 〉 11.1 mmol/L were treated with CSII for 2 weeks. Fasting plasma glucose （FPG）, 2 hours postprandial glucose （2hPG）, glycosylated hemoglobin Alc（ HbAlc）, Homa-[3. and Homa-IR index were evaluated before and after CSII intensive treatment. All patients were followed up for 12 months. The reasons of inadequate glycemic control during follow-up time were analyzed. Results：Mter 2 weeks CSII intensive treatment, FPG, 2hPG and HbA1 c lever were reduced significantly （ P 〈 0. 001 ）, Homa-[3 index were significant increased （ P 〈 0.01 ） and Homa-IR index were significant decreased （P 〈0.05）. In all of patients 17 patients （65.38%） with good glycemic control were only on diet and physical exercise during 12 months followed up, their Homa-[3 and Homa-IR index were remained no significant changes （P 〉 0.05 ）. Compared with the good glycemic control group, baseline of HbAlc, time of excellent control of FPG and 2hPG and dosage of insulin usage were significant higher in the inadequate glycemic control group （9 patients, 34.62%, P 〈 0.05 ）. Conclusion：Short-term CSII intensive treatment in newly diagnosed type 2 diabetic patients with severe hyperglycemia can improve and/or restore β-cell function. The patient might be brought back to a stage that diet control and exercise are still quite efficacious for their glycemic control.