不同方案短期强化血糖控制对短病程2型糖尿病患者的影响

β cell function and insulin resistance in type 2 diabetic patients with short disease duration treated with different short term intensive glycemic control

目的 探讨单纯口服降糖药（OHA）、单纯胰岛素强化治疗（Ins）以及口服降糖药联合胰岛素（OHA＋Ins）治疗对短病程、未用过降糖药的2型糖尿病（T2DM）患者减轻胰岛素抵抗、改善胰岛功能的效应差异。方法90例病程≤1年、未用过降糖药的T2DM患者随机分为3组，即OHA组、Ins组和OHA＋Ins组。每组有效病例30人，进行强化降糖治疗，以末梢空腹血糖≤6．0mmol／L和餐后2h血糖≤8．0mmol／L为血糖控制目标，使血糖在7～10d达标，并维持达标2～4周。比较3组治疗前后的静脉葡萄糖耐量试验（IVGTT）胰岛素第一时相分泌、胰岛素抵抗指数（Homa A）和胰岛素分泌指数（Homa B）的变化。结果3组治疗后IVGTT曲线下面积和Homa B均明显升高，Homa A明显下降。3组间治疗前后变化的差别不显著。结论 3种强化降糖治疗方案均可以使短病程、未甩过降糖药的T2DM患者的胰岛素抵抗以及胰岛β细胞功能得到同样程度的改善。

Objective To investigate the insulin resistance and β cell function in short disease duration and naive type 2 diabetic patients treated with oral hypoglycemic agents （OHA） ,insulin or combining insulin and OHA. Methods Ninety newly diagnosed and naive type 2 diabetic patients（ the diabetic duration ≤ 1 year） were randomly divided into three groups,treated with OHA,insulin or combining therapy separately, Each group included 30 cases and was put on intensive glycemic control, The targets for glycemic control were fasting blood glucose less than 6.0 mmol/L, and two hours postprandial blood glucose less than 8, 0 mmol/L,which were achieved in 7-10 days, and had been lasted for 2-4 weeks, Before and after intensive therapy, intravenous glucose tolerance test （IVGTT） was performed to calculate AUCIns0-10 min, Homa A and Homa B, Results After intensive treatment,AUCIns0-10 min. and Homa B increased,but Homa A decreased in three groups, There were no differences among three groups, Conclusion The same excellent improvement of insulin sensitivity and β cell function can be obtained by three ways of intensive glycemic treatment in short disease duration and naive type 2 diabetic patients.