早期强化治疗与常规治疗初诊2型糖尿病患者β细胞功能与胰岛素抵抗变化的比较

The comparison of islet β-cell function and insulin resistance between glucose-in-target-level therapy and routine therapy in patients with newly diagnosed type 2 diabetes

目的探讨强化治疗与常规治疗对初诊T2DM患者胰岛β细胞功能和胰岛素抵抗(IR)的影响。方法初诊T2DM患者选用非胰岛素促泌药物治疗后,HbA_1c≤6.5%者53例,>6.5%者58例,对OGTT血糖、Ins、HOMA-β、HOMA-IR进行组间比较。结果与常规组比较,达标组OGTT的5个时点血糖均显著降低(P均<0.01);180min Ins明显降低(P<0.05),其他时点Ins也降低,但无统计学差异(P>0.05);HOMA-IR明显降低,HOMA-β明显升高(P均<0.05);葡萄糖处置指数显著升高(P<0.01);△I_(30)/△G_(30)和AUC_(Ins)组间差异无统计学意义(P>0.05)。结论初诊T2DM患者早期血糖强化达标治疗比常规治疗更能有效改善高血糖状态,减轻IR程度,提高β细胞基础分泌功能。

Objective To compare islet β-cell function and IR in newly diagnosed type 2 diabetes mellitus between glucose-in-target-level therapy and routine therapy. Methods Newly diagnosed type 2 diabetic patients were treated for 12 months with insulin or metformin or acarbose or pioglitazone. Two groups with HbA1c≤6.5% （n= 53） and 〉6. 5% （n= 58） were divided. Levels of OGTT-glucose, insulin and indexes of β-cell function were compared between two groups. Results In glucose-in-targetlevel versus routine therapy group： （1）levels of blood glucose in OGTT were significantly decreased（P〈0. 01）. （2）levels of insulin were not markedly different（P〉0. 05） except 180 min（P〈0. 05）. （3）HOMA-IR was significantly decreased （P 〈 0. 05） ; HOMA-β and DI were significantly increased （ P 〈 0. 01 and P 〈 0. 05）. However, △I30/△G30 and AUCins were not markedly different（P〉0. 05 ）between two groups. Condusions Early glucose-in-target-level therapy versus routine therapy could decrease hyperglycemia and insulin resistance, increase insulin secretion at baseline in newly diagnosed type 2 diabetes mellitus patients.