2型糖尿病患者初始胰岛素剂量与代谢参数的关系

Relationship between Initial Insulin Dosage and the Metabolic Parameters in Patients with Type 2 Diabetes

目的:分析2型糖尿病患者初始胰岛素剂量与代谢参数之间的关系,探索更合理估计初始胰岛素剂量的方法。方法:收集初次应用胰岛素治疗的2型糖尿病住院患者164例,询问病史,测量身高、体质量、腰围、臀围、血压,检测空腹血糖、胰岛素、C肽、糖化血红蛋白(HbA1c)、血脂,进行精氨酸试验。结果:2型糖尿病患者的初始胰岛素剂量与胰岛素抵抗指数(HOMA-IR)(r=0.416,P<0.001)、空腹胰岛素(r=0.372,P<0.001)、三酰甘油(TG)(r=0.212,P=0.007)、空腹血糖(r=0.180,P=0.021)、腰围(r=0.170,P=0.029)、精氨酸试验的血糖曲线下面积(r=0.167,P=0.032)呈正相关。在糖尿病病程≤1年的患者中,空腹胰岛素和C肽水平、HOMA-IR是影响初始胰岛素剂量的主要因素,回归方程分别为:初始胰岛素剂量=1.031×空腹胰岛素-2.975×空腹C肽+24.56,或初始胰岛素剂量=1.256×HOMA-IR+22.489。在糖尿病病程>1年的患者中,腰围、TG和空腹血糖水平是影响患者初始胰岛素剂量的主要因素,回归方程分别为:初始胰岛素剂量=0.381×空腹胰岛素-4.506×高密度脂蛋白胆固醇HDL-c+31.83,或初始胰岛素剂量=0.206×腰围+0.585×TG+0.668×空腹血糖+3.709。结论:空腹胰岛素、空腹C肽、HOMA-IR是新诊断2型糖尿病患者的初始胰岛素剂量的主要影响因素。空腹胰岛素、HDL-c、腰围、TG和空腹血糖是病程超过1年的2型糖尿病患者初始胰岛素剂量的影响因素。

Objective：To analyze the relationship between initial insulin dosage for type 2 diabetes（T2D） and the metabolic parameters and to explore a more reasonable method for evaluating the initial insulin dosage.Methods： We enrolled 164 inpatients with T2D who initially treated with insulin and collected their data including personal history,height,weight,waist and hip circumferences,blood pressure and the laboratory examinations including fasting blood glucose,insulin and C peptide,HbAlC,lipid profile.All the patients performed the arginine stimulating test to observe the acute phase secreting function of β cells.Results： The initial insulin dosage for patients with T2D was positively related to HOMA-IR（r=0.416,P0.001）,fasting blood insulin（r=0.372,P0.001）,triglyceride TG（r=0.212,P=0.007）,fasting blood glucose（r=0.180,P=0.021）,waist circumference（r=0.170,P=0.029）,area under the blood glucose curve in arginine stimulating test（r=0.167,P=0.032）.In the patients with a diabetes history no more than 1 year,fasting blood insulin and C peptide,HOMA-IR were the main impact factors and the regression equations were respectively as follows,initial insulin dosage=1.031×fasting blood insulin-2.975×fasting C peptide＋24.56,and initial insulin dosage=1.256×HOMA-IR＋22.489;on the other hand,among patients with a diabetes history more than 1 year,waist circumference,TG and fasting blood glucose were the main impact factors,the regression equations were respectively as follows,initial insulin dosage = 0.381×fasting blood insulin-4.506×HDL-c＋31.83,and initial insulin dosage=0.206×waist circumference＋0.585×TG＋ 0.668×fasting blood glucose＋3.709.Conclusions： Fasting blood insulin,fasting C peptide,HOMA-IR were the main impact factors of the initial insulin dosage for newly diagnosed type 2 diabetic patients.Fasting blood insulin,HDL-c,waist circumference,TG and fasting blood glucose are the impact factors of the initial insulin dosage for type 2 diabetic patients with a history more than 1 year.