胰岛素泵在2型糖尿病强化治疗中应用观察

Effect of treating hyperglycemia of type 2 diadetes with insulin pump

目的探讨采用胰岛素泵持续注射胰岛素强化治疗对2型糖尿病患者胰岛β细胞功能、血糖控制的影响。方法63例空腹血糖≥12mmol／L的2型糖尿病患者，不合用其他口服降糖药，给予胰岛素泵强化治疗，观察达到目标血糖（FPG≤7mmol／L，CBG≤10mmol／L）天数以及胰岛素的基础量和餐前追加量，分析比较其治疗前后FPG、CBG、HbA1c、FINS／FPG、ISI、Homa-B和Homa．IR等。结果达目标血糖的平均天数为（5．4±1．6）d，所用胰岛素量为（0．6±0．2）U／kg．其中基础率占38％，在血糖控制后，胰岛素用量显著减少。发生低血糖反应（0．6±0．2）次。与治疗前相比，胰岛素泵强化治疗后FPG[（16．0±3．2）mmo[／L，（6．5±0．8）mmol／L]、CBGl（18．0±2．0）mmo[／L，（7．5±1．3）mmol／L]、HbA1c【（11．6±1．8）％，（8．6±1．2）％]、HOMA．IR[（0．3±0．1），（0．3±0．2）]均明显下降（均P〈0．01）；FINS／FPG[（1．2±0．5），（1．5±0．6）]、HOMA．B[（0．8±0．2），（1．7±0．2）]、ISI[（3．4±0．5），（3．9±0．3）]均明显升高（均P〈0．01）。结论对伴明显高血糖的2型糖尿病患者，短期胰岛素泵持续注射胰岛素强化治疗具有快速控制血糖和显著改善患者胰岛8细胞功能的作用。

Objective To investigate and analyze the effect and insulin dosage of insulin pump in type 2 diabetes. Methods 63 hospital patients with type 2 diabetes（FPG≥12mmol/L） ,who had poorly controlled blood glucose,were treated by insulin pump for 14 days,without hypoglycemic agents. The treatment days when blood glucose was well controlled and the insulin dosage at that time were observed. FPG, CBG, HbAc, FTNS/FPG, ISI, Homa-B and Homa-IR were measured before and after insulin pump. Results When blood glucose were well controlled,the mean time was （5.4 ± 1.6） days, the insulin was （0.6 ± 0.2 ） U/kg, the basal insulin was 38 %. The dosage of insulin was decreased after blood glucose were controlled. Reaction of hypoglycemia was （0.6 ± 0.2）. After 2 weeks insulin pump intensive treatment,the result of FPG,CBG, HOMA-IR and HbAlc were significantly decreased（all P 〈 0.01 ） ; FINS/FPG, HOMA-B and ISI were incleased（all P 〈 0.01）. Conclusion The excellent glycemic control and improvement of beta-cell function can be induced by short-term insulin pump intensive therapy in diagnosed type 2 diabetic patients with severe hypoglycemia.