初诊2型糖尿病患者胰岛素泵强化治疗的长期疗效观察

A long-term clinical investigation on intensire insulin pump treatment in newly diagnosed type 2 diabetes

目的探讨初诊2型糖尿病患者短期胰岛素强化治疗后的长期疗效及长期缓解的影响因素。方法 60例初诊T2dM患者,随机分为2组,胰岛素泵强化治疗组(治疗组)和口服药对照组(对照组),各30例,治疗组经2周胰岛素泵强化治疗后,给予饮食及运动干预,若血糖不达标,则加用降糖药物;对照组仅给予饮食及运动干预,如血糖不达标,予口服降糖药物,2组患者均不用噻唑烷二酮类药物。追踪观察至少1年。结果①与强化治疗前相比,强化治疗后及1年后随访的FPG、2hPG、HOMA-IR、FINS、2hINS、TG、TC均明显降低,HOMA-β较治疗前明显升高。②对照组治疗后及1年后随访FPG、2hPG、HOMA-IR、FINS、2hINS、TG、TC有所降低,HOMA-β较治疗前明显升高(P<0.05)。③两组间比较:治疗组FPG、2hPG、HOMA-IR、FINS、2hINS明显降低,HDL、HOMA-β明显升高(P<0.05)。结论短期胰岛素泵强化治疗,可改善T2dM患者的病理生理缺陷,较肥胖的以较低胰岛素量即能达到良好控制血糖、恢复胰岛β细胞功能的初诊T2dM患者,获得长期缓解的可能性较大。

Objective To explore the influence factors for long-term curative effect and remission by short-term intensive insulin pump treatment in newly diagnosed type 2 diabetes. Methods A total of 60 inpatients with newly diagnosed T2 dM were are redomly devided into two group-the cure and the contrast. The cure group （30 patients） received a two-week course of insulin therapy, and after that, diet and exercise therapy were given, if not in good glycemic control, oral hypoglycemic agents （OHA） were given. The contrast group （ 30 patients） received diet and exercise therapy, if not in good glycemic control, oral hypoglycemic agents （OHA） were given either. All patients were followed at least one year along. Results （1） In postinsulin therapy versus preinsulin theraphy group, 1 year follow-up data showed FPG, 2 hPG, HOMA-IR, FINS ,2 hINS, TC and TG were all significantly lower and the HOMA-β, HDL were significantly higher （ all P 〈 0. 05 - 0. 01 ）. （2） The cure group, 1 year follow-up data showed FPG, 2 hPG, HOMA-IR, FINS, 2 hINS, TC and TG were all significantly lower and the HOIVIA-β, HDL were significantly higher than the contrast （ P 〈 0.05 ）. Conclusion The shortterm intensive insulin pump treatment can improve the defect of pathophisiology of diabetes. The subjects with newly diagnosed T2 dM with lage wight and BMI be more easy to have good glucose control with lower insulin dosage and better improvement of β-cell secretion function, and have more possibility for long-term remission.