不同病程初发2型糖尿病对胰岛素短期强化治疗的反应

Response to insulin intensive therapy in patients with newly diagnosed type 2 diabetes at different stages

目的糖尿病初期胰岛素强化治疗可改善胰岛β细胞功能,但治疗时机尚无一致意见。本研究分析了不同病程初发2型糖尿病患者短期胰岛素强化治疗的胰岛β细胞功能改善程度。方法对2007年2月以来我科诊治的空腹血糖≥11.1mmol/L的初发2型糖尿病患者91例进行胰岛素强化治疗,对糖尿病病程在1周内组(A组,n=41)和12周以上组(B组,n=29)的患者进行分析总结。患者均行口服糖耐量试验测血糖和胰岛素、糖化血红蛋白(HbA1c)、糖化血清蛋白、血脂、尿酸、肝肾功能。每日4次三短一中胰岛素强化治疗4周后复测上述指标。采用稳态模型(HOMA)计算胰岛素抵抗指数(HOMA-IR)和胰岛素分泌指数(HOMA-β)。结果 A组和B组患者治疗后与治疗前相比,空腹血糖、糖化血清蛋白、HbA1c、甘油三酯、胆固醇、低密度脂蛋白胆固醇、收缩压和舒张压均有明显下降(P<0.05),尿酸水平有所上升(P<0.05),但两组相比无差异。两组患者强化治疗4周后HOMA-IR较治疗前无差异,而HOMA-β较治疗前有明显改善(P<0.05),A组HOMA-β改善程度好于B组(P<0.05)。以强化4周后HOMA-β为因变量,进行多因素回归分析,影响因素有体重指数、血压、甘油三酯水平、血糖达标时间、治疗前后HbA1c和糖化血清蛋白差值。结论糖尿病病程1周内进行强化治疗,胰岛β细胞功能改善好于病程12周以上,说明病程越短治疗效果越好。

Objective To study the effect of short-term intensive insulin therapy on beta-cell function in different courses of newly diagnosed type 2 diabetic patients. Methods Ninety-one newly diagnosed type 2 diabetic patients with fast blood glucose （FBG） 11.1 mmol/L received insulin intensive therapy for 4 weeks. We analyzed the data from 41 cases within 1 week course （group A） and 28 cases over 12 weeks course （group B）. All 69 patients underwent glucose tolerance test. Insulin,glycosylated glycohemoglobin （HbA1c）,albumin,blood pressure,lipid level and uric acid were also tested before and after intensive insulin therapy. HOMA-β and HOMA-IR were calculated. Results After insulin intensive therapy,FBG,albumin,HbA1c,triglyceride,low density lipoprotein-ch,systolic blood pressure,and diastolic blood pressure decreased dramatically and uric acid increased markedly in all patients （P0.05）,while there was no difference between group A and B. There was improvement in HOMA-β but not in HOMA-IR after therapy. The improvement of HOMA-β in group A was much better than that in group B. Conclusion The shorter the course of diabetes mellitus is,the better the beta-cell function will be improved. Early awareness and early treatment of type 2 diabetes are strongly recommended.