早期强化降糖治疗对2型糖尿病患者胰岛功能的影响

Effects of early intensive insulin treatment on islet β cell function in type 2 diabetic patients

目的观察皮下多次注射胰岛素（MSII）强化降糖治疗对新发及病程1～5年的2型糖尿病患者胰岛β细胞功能的影响。方法选取2007年6月—2010年6月于本院门诊和住院就诊的血糖控制不佳的2型糖尿病患者128例（新发92例，病程1—5年36例），予MSII强化降糖治疗达标，治疗前、后分别行口服葡萄糖耐量联合胰岛素释放试验。计算早相胰岛素分泌指数（△INS30／ABG30）、稳态模型评估-胰岛素分泌指数（HOMA—IS）、稳态模型评估一胰岛素抵抗指数（HOMA—IR）及胰岛素分泌曲线下面积（AUC。）。结果所有患者经MSII治疗后胰岛素分泌功能均有不同程度的恢复，治疗后AINS30／ABG30、HOMA—IS、AUCINS明显提高（P〈0．05）；总组分析治疗前、后HOMA—IR分别为（3．12±2．72）w．（3．06±1．92），差异无统计学意义（P=0．16）。亚组分析显示病程1～5年2型糖尿病患者治疗前、后HOMA—IR分别为（3．83±2．07）vs（2．70±1．38），P〈0．01。新发2型糖尿病治疗后AINS30／ABG30、HOMA—IS、AUC№明显提高，差异有统计学意义（P〈0．05），而HOMA—IR治疗前、后差异无统计学意义（P=0．154）。结论对血糖水平较高的新发及病程1～5年的2型糖尿病患者予MSII强化降糖治疗，可明显改善胰岛8细胞分泌功能及胰岛素抵抗，恢复早相分泌，提高胰岛素敏感性。

Objective To investigate the effects of multiple insulin subcutaneous injection （MSII） early intensive therapy on β cell function in patients who have had newly diagnosed type 2 diabetes, and for 1 to 5 years. Methods A total of 128 patients, including 92 newly diagnosed type 2 diabetes and 36 who have had it for 1 to 5 years, with severe hyperglycemia had been recruited to participate the MSII therapy at the clinic and inpatient departments of our hospital from June 2007 to June 2010. OGTT and INS release test were examined before and after the MSII. The Index of early-phase insulin secretion （ AINS30/ABG30）, the mean area under the curve （AUCINs） of insulin, HOMA-IS and HOMA-IR before and after the MSII were compared to evaluate β cell function. Results After the MSII intensive therapy, all participants had different extents of improvements on β cell function. The A INS30/A BG30, HOMA-IS and AUCINs after MSII were significantly increased （ P 〈 0. 05 ）. HOMA-IR of the whole group before and after therapy were （ 3.06±1.92） and （3.12 ±2.72） ,respectively, which has no significant difference （P = 0.16）. The subgroup results showed that the HOMA-IR in patients who have had type 2 diabetes from 1 to 5 years were （3.83 ± 2.07） and （2.70 ± 1.38） before and after therapy, respectively （ P 〈 0.01 ）. In the new diagnosed type 2 diabetes subgroup, A INS30/A BG30, HOMA-IS and AUCtNs were increased after the therapy, which showed significant difference before and after therapy （P 〈 0.05 ）. However, there was no significant difference for HOMA-IR in this subgroup before and after therapy （P - 0. 154）. Conclusions Patients with newly diag- nosed type 2 diabetes and who have had type 2 diabetes from 1 to 5 years, both with severe hyperglycemia, can use MSII early intensive therapy. It can significantly improve the islet β cell function and insulin resistance, increase the early-phase insulin secretion and insulin sensitivity.