初诊2型糖尿病强化胰岛素治疗对胰岛β细胞功能的影响分析

Effect of insulin intensive therapy on β-cell function of pancreatic islet newly diagnosed type 2 diabetes

目的:探讨不同疗程的强化胰岛素治疗对初诊2型糖尿病患者胰岛β细胞功能的影响。方法:对初诊2型糖尿病患者72例随机分成:对照组24例,给予口服降糖药治疗;治疗1组24例,给予诺和灵R+N(3+1)强化治疗2周后改口服药治疗;治疗2组24例,给予诺和灵R+N(3+1)强化治疗8周;血糖控制目标:空服血糖<7.0 mmol/L,餐后两小时血糖<10.0 mmol/L,治疗前和8周终点结束时给予100 g馒头餐试验,测定空腹血糖(FBS),餐后两小时血糖(PBS),糖化血红蛋白,胰岛素分泌指数(HOMA-β),胰岛素抵抗指数(HOMA-IR),C肽,所有患者随访1年。结果:三组治疗后空腹血糖,糖化血红蛋白,餐后两小时血糖均较治疗前明显下降(前两者P<0.05,后者P<0.01);治疗1组和2组C肽,HOMA-β较前明显升高(P<0.05),C肽高峰前移到1小时,HOMA-IR较治疗前明显下降(P<0.05);对照组C肽,HOMA-β较前有升高,HOMA-IR较治疗前有下降,但差异无显著性(P>0.05);随访1年,对照组用药量无变化,无停药者,治疗1组用药量较前有减少(约18%～20%),4例停药,治疗2组,用药量较前明显减少(约30%～36%),7例停药。结论:对初诊2型糖尿病患者给予强化胰岛素治疗可以明显改善患者胰岛β细胞功能,诱导血糖长期稳定控制,减少用药量,甚至停药,尤其以中长程强化胰岛素治疗效果明显。

Objective ：To observe the effect of insulin intensive therapy with varied courses on β-ceU function of pancreatic islet in newly diagnosed type 2 diabetes patients.Methods ：To randomize 72 patients with newly diagnosed type 2 diabetes into three groups：control group of 24 cases was treated with oral lowering blood glucose medicine,treatment group Ⅰ of 24 cases with oral lowering blood glucose medicine after 2 weeks of nuoheling （R plus N ,3＋1） intensive therapy ,and treatment group Ⅱ of 24 cases with 8 weeks of nuoheling （R plus N,3＋1 ） intensive therapy.The objective of blood glucose control was：FPG〈7.0 mmol/L,and 2hPG〈10.0 mmol/L.Before and after 8 weeks of treatment, the FBS,PBS, HbA1C, HOMA-β, HOMA-IR and C-peptide were determined through standard bread meal test. All the patients were foUowed up for 1 year.Results：After treatment,FBS,HbA1C and PBS were significantly decreased in each group（FBS： P〈0.05,HBA1C ：P〈0.05 ,PBS：P〈0.01 ）,while in the treatment groups Ⅰ and Ⅱ ,C-peptide and HOMA-13were significantly increased（P〈 0.05） ,the pinnacle of C-peptide was moved ahead in the lst hour,and HOMA-IR was significantly decreased （P〈0.05）. In the control group,C-peptide and HOMA-β were increased,and HOMA-IR was decreased without significant difference （P〉0.05）. Meanwhile the Follow-up was for 1 year,drugs dose had no change and no patient stopped drug in the control group,while drugs dose was decreased （18%-20%）and 4 patients stopped drug in the treatment group Ⅰ ,and drugs dose was significantly decreased（30%-36%） and 7 patients stopped drug. Conclusion： Insulin intensive therapy not only can improve the β-cell function in newly diagnosed type 2 diabetes patients to induce blood glucose controled chronically and steadily, but also can reduce the drugs dose even withdrawal drug, especially in mid-long intensive therapy with obvious effect.