新诊断的2型糖尿病患者短期胰岛素强化治疗后肠促胰岛素的变化

Effects of short-term intensive insulin therapy on the levels of incretins in newly diagnosed type 2 diabetes

目的观察新诊断的T2DM患者短期胰岛素泵强化血糖控制后肠促胰岛素的变化及其与β细胞功能变化的关系。方法选择21例新诊断的T2DM患者接受为期14d的持续皮下胰岛素注射,于治疗前和治疗14d后分别行75g OGTT,检测0min、30min、120min静脉血糖、胰岛素、C肽、胰升血糖素样肽1(GLP-1)、葡萄糖依赖性促胰岛素分泌多肽(GIP)、胰升血糖素水平。并检测17例血糖正常对照者GLP-1水平。结果糖尿病患者治疗前0min、30min、120min血GLP-1水平及GLP-1曲线下面积(0-30-120min AUC)较正常对照者均显著降低(P<0.05);强化治疗后0min、30min、120min GLP-1水平及曲线下面积较治疗前均明显升高(P<0.01);而GIP水平及曲线下面积无明显变化(P>0.05),胰升血糖素则有明显下降(P<0.05)。同时HOMA-β指数及△INS30/△G30、△INS120/△G120明显升高(P<0.05),HOMA-IR指数显著降低。结论新诊断T2DM患者经短期胰岛素强化治疗后,GLP-1水平升高,胰升血糖素水平降低可能与胰岛β细胞功能与胰岛素抵抗得到改善有关。

Objective To observe the effect of short-term intensive insulin therapy on the levels of incretins and islet β-cell function in the newly diagnosed type 2 diabetic patients. Methods Twenty-one newly diagnosed type 2 diabetic patients were treated with continuous subcutaneous insulin infusion（CSII） for 14 days.Before and after intensive insulin therapy,oral glucose tolerance test（OGTT）and insulin release test（IRT） were performed.The levels of plasma glucose,insulin,C-peptide,glucagon like peptide-1（GLP-1）,glucose-dependent insulinotropic polypeptide（GIP） and glucagon were examined in 0min,30min,120min respectively.The plasma GLP-1 levels of 17 controls with normal plasma glucose were also detected. Results Before intensive insulin therapy,the levels of plasma GLP-1 and the mean area under the curve（AUC） of GLP-1 were lower obviously in newly diagnosed type 2 diabetic patients than in the controls.After versus before intensive insulin therapy,the levels of plasma GLP-1 and the AUC of GLP-1 were increased markedly（P〈0.01）,while plasma glucagon levels were decreased（P〈0.05）.The homeostatic model assessment of the insulin secretion index（HOMA-beta）,△INS30/△G30,△INS120/△G120 were increased significantly（P〈0.05）,while the homeostatic model assessment of insulin resistance index（HOMA-IR）decreased markedly after treatment versus before. Conclusions The short-term intensive insulin therapy could increase plasma GLP-1 levels and reduce plasma glucagon levels in newly diagnosed type 2 diabetic patients,which might be related to the improvement of islet β-cell function and insulin resistance.