短期胰岛素泵治疗初诊2型糖尿病患者的随访研究

Follow-up of newly-diagnosed type 2 diabetic patients treated with short-term continuous subcutaneous insulin infusion

目的观察短期应用胰岛素泵治疗初诊2型糖尿病的中远期疗效及不良反应。方法观察、随访、回顾性分析256例初诊2型糖尿病患者经胰岛素泵（CSII）强化治疗2周后控制血糖情况、不服用药物血糖达标（空腹血糖：3．9～7．0mmol／L，餐后2h血糖：3．9～10．0mmol／L）持续时间（缓解期）等。结果CSII治疗3d血糖达标率46．7％，7d达标率78．4％，2周达标率92．2％；拆除胰岛素泵缓解期超过3个月的患者共192例（75％），超过6个月166例（64．8％），超过12个月137例（53．5％），超过24个月79例（30．9％），超过36个月26例（10．2％），无1例超过48个月。缓解期少于3个月的患者，其停用胰岛素时的剂量明显高于缓解期超过3个月的患者（P〈0．01），停用胰岛素时的剂量与缓解期的长度呈负相关（r=-0．63，P〈0．01）。结论CSII可迅速有效使初诊2型糖尿病患者血糖达标，消除高血糖的毒性作用，使受糖毒性损伤的残存胰岛β细胞功能得到一定程度恢复，可延缓胰岛β细胞功能的衰退。

Objective To investigate the therapeutic and adverse effects of short-term continuous subcutaneous insulin infusion （CSII） in patients with newly-diagnosed type 2 diabetes mellitus. Methods By way of follow-up and retrospective study, 256 patients with newly-diagnosed type 2 diabetes mellitus receiving two weeks of CSII therapy were analyzed in our diabetes center. The parameters, such as blood glucose level after two-week CSII therapy, time needed to control hyperglycemia, insulin dosage and the rate of hypoglycemic episodes were observed and recorded. Results The optimal glycemic control rates after 3 days, 7 days, 2 weeks were 46.7%, 78.4%, 92.2% respectively. The remission rates of patients who maintained optimal glycemic control at the third, sixth, twelfth, twenty-fourth and thirty-sixth months and more than 48 months after withdrawal of insulin were 75%, 64.8%, 53.5%, 30.9%, 10.2% and 0%, respectively. In patients with a period of remission over 3 months, the daily total insulin requirement on the day of withdrawal of CSII was less than that in patients with remission less than 3 months （ P 〈 0.01 ）. The duration of remission was negatively correlated to daily insulin requirement on the day of CSII withdrawal （ r = - 0.63, P 〈 0.01 ）. Conclusion Patients with newly-diagnosed type 2 diabetes mellitus can quickly achieve optimal glycemic control by CSII. CSII may decrease glueotoxieity to pancreatic β cells and delay the deterioration of β-cell function .