胰岛素泵对初诊及口服降糖药失效的2型糖尿病的疗效比较

Comparison of the effect of insulin pump therapy on treating newly diagnosed T2DM patients who failed in oral antidiabetic therapy

目的分析比较胰岛素泵强化治疗初诊及口服降糖药失效的2型糖尿病的疗效。方法对40例初诊2型糖尿病（A组）及96例口服降糖药失效的2型糖尿病（B组）患者,给予胰岛素泵强化治疗,疗程5～9 d,观察达到目标血糖（空腹血糖〈7.0 mmol/L,餐后2 h血糖〈10 mmol/L）控制的天数以及撤泵时胰岛素用量,并分析与上述指标相关的因素。结果A组血糖达良好控制的平均天数为（3.60±1.88）d,胰岛素的用量为（32.50±14.52）U,发生生化低血糖（0.45±0.49）次/人。B组血糖达良好控制的平均天数为（5.08±2.22）d,胰岛素的用量为（44.73±14.86）U,发生生化低血糖（0.52±0.77）次/人。结论经过胰岛素泵的强化治疗,A组在血糖达标天数及胰岛素用量均小于B组,经多元回归分析,影响血糖达标时间的因素为年龄、病程及治疗前空腹血糖,影响胰岛素用量的因素为糖尿病的病程、体重指数、糖化血红蛋白及空腹胰岛素抵抗指数。

Objective To study and analyze the effect of insulin pump therapy on treating hyperglycemia in newly diagnosed type 2 diabetes mellitus（T2DM） patients who failed in oral antidiabetic therapy. Methods Forty patients with newly diagnosed T2DM （A group） and 96 T2DM patients who failed to oral antidiabetic therapy （ B group） were treated by insulin pump for 5 - 9 days. During the treatment days blood glucose was well controlled （fasting blood glucose 〈 7.0 mmol/L, postprandial 2 h blood sugar 〈 10 mmol/L） and the insulin dosage at that time were observed. The related factors for the therapeutic effects were analyzed. Results When blood glucose were well controlled, the mean time was （ 3.60 ± 1.88 ） days, the average insulin dose was （32.50 ±14.52 ） U/d, the average frequency of biochemical hypoglycemia was （ 0.45 ± 0.49） （times/per patient） in A group. The mean time was （5.08 ± 2.22 ）days, the average insulin dosewas （44.73 ± 14.86）u/d, the average frequency of biochemical hypoglycemia was （0.52 ± 0.77 ） （times/per patient） in B group. Conclusion The mean time and the dosage of insulin for blood glucose to be targeted in A group were significantly lower than those in B group （ P 〈 0.05 ）. Multiple regression analysis showed that age, duration of diabetes and fasting blood glucose level were the factors that affect the time for blood glucose to be targeted, and duration of diabetes, body mass index（BMI）, HbAlc and insulin resistance indexes （HOMA-IR） affect the required insulin dosage.