新诊断2型糖尿病胰岛素治疗后胰岛功能的动态变化

Influence of short-term intensive insulin therapy on pancreatic β-cell function in newly diagnosed type 2 diabetes mellitus

目的:观察短期胰岛素治疗对初诊断2型糖尿病(T2DM)患者胰岛β细胞功能的影响,探讨胰岛素治疗的时间。方法:对36例空腹血糖(FPG)≥10mmol/L的初诊断T2DM患者入院行胰岛素强化治疗14d(3餐前予以诺和灵R,睡前予以诺和灵N皮下注射),血糖控制平稳出院,后改为诺和灵30R继续治疗,胰岛素治疗共3个月。于治疗前及治疗后14d及3个月比较各时间点血糖(PG)、胰岛素、C肽;稳态模型评估法评估β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)及胰岛素分泌指数等指标的变化。结果:胰岛素治疗14d后血糖、HOMA-IR明显下降(P<0.05),胰岛素及C肽、HOMA-β、△C30/△G30、△C120/△G120明显升高(P<0.05);治疗3个月后较治疗14d血糖均控制在理想水平,且无明显变化,但其余指标改善更加明显(P<0.05)。结论:短期胰岛素治疗初诊断T2DM患者,能显著改善β细胞功能,且随治疗时间延长,胰岛功能有进一步的改善。

Objective： To investigate the influence of short-term intensive insulin therapy on pancreaticβ-cell function in patients with newly diagnosed type 2 diabetes mellitus（T2DM） and determine the time of insulin therapy. Methods： Thirty-six patients with T2DM diagnosed newly and fasting plasma glucose （FPG）≥ 10mmol / L were hospitalized and undergoing 14 d intensive insulin therapy （Novolin R injected hypodermically before three meals, Novolin N injected hypodermically before bedtime）, and discharged after control of the abnormal blood glucose, then used Novolin 30R to treat continuously, and the course of insulin therapy was 3 months. Blood glucose （PG） , insulin and C-peptide were determined before treatment, 14d and 3 months after treatment.β-cell function index（ HOMA-β）, insulin resistance index（HOMA-IR） and insulin secretion index were assessed respectively using homeostasis model assessment method. Results： Forteen days after insulin treatment, PG, HOMA-IR decreased significantly （P 〈 0.05 ） , insulin and C-peptide, HOMA-β, △C30/△ G30, △ C120/△ G120 increasedsignificantly （P 〈 0.05 ） ; 3 months after insulin treatment, PG levels were normal as that in 14 days, and no significant change occurred, but the other parameters improved more pronounced than that in 14 days （P 〈 0.05）. Conclusion ： Therapy of newly diagnosed T2DM with short-term intensive insulin can improve pancreatic β-cell function, and with the therapy time lengthening, the β-cell function improves further.