口服降糖药对比两种预混胰岛素治疗对LADA患者胰岛β细胞功能影响的观察

Effects of BIAsp30,BHI30 and OADs treatment on the β-cell function of LADA patients

目的观察门冬胰岛素30(BIAsp30)、预混人胰岛素30R(BHI30)和口服降糖药(OADs)对LADA患者胰岛β细胞功能影响。方法 146例LADA患者随机分为A、B、C 3组,分别予以BI-Asp30、BHI30和OADs治疗。分别检测和比较血糖、HbA1c和C-P水平。结果治疗前3组血糖、HbA1c、C-P差异无统计学意义(P>0.05);治疗后A、B两组血糖、HbA1c较治疗前明显降低,A、B组间比较差异无统计学意义(P>0.05),与C组比较血糖明显下降,差异有统计学意义(P<0.01);与治疗前相比C-P均有降低,A、B组间比较差异无统计学意义(P>0.05),A、B组与C组比较差异有统计学意义(P<0.01);C组血糖、HbA1c控制差,血糖波动大;C-P下降明显,其中大部分患者2～3年内改为胰岛素治疗。结论 OADs治疗LADA患者血糖和HbA1c达标率低、波动大,胰岛β细胞功能衰减快,其中大部分LADA患者2～3年内改为胰岛素治疗。BIAsp30和BHI30均较OADs明显改善血糖控制和胰岛功能,所以新诊断T2DM患者建议行胰岛细胞抗体检测,LADA患者确诊后应尽早使用胰岛素治疗。

Objective To observe the effect of BIAsp30,BHI30 and oral antidiabetic agents（OADs） on the β-cell function of the latent autoimmune diabetes in adult（LADA） patients.Methods The 146 LADA patients were randomized into A,B,and C groups and treated with BIAsp30,BHI30 and OADs respectively.Their blood glucose,HbA1c,and C-peptide（C-P） were tested and compared.Results Before treatment,the levels of blood glucose,HbA1c,and C-P of the 3 groups were not significantly different（P〉0.05）.After treatment,the blood glucose and HbA1c of groups A and B were significantly decreased,the difference between these 2 groups was not statistically significant（P〉0.05）,while the blood glucose was significantly decreased as compared with group C,and the difference was statistically significant（P〈0.01）.Compared with before treatment,C-P was decreased in all 3 groups,the difference between groups A and B was not statistically significant（P〉0.05）,whilst there was a statistical difference in the comparison of groups A and B with C（P〈0.01）.In group C,the control of blood glucose and HbA1c was poor and the level of blood glucose was always fluctuated,the decrease of C-P was significant,and most of the patients were transferred to insulin treatment within 2~3 years.Conclusion The LADA patients with OADs treatment have a lower rate of targeted blood glucose and HbA1c,and the fluctuations of blood glucose and HbA1c levels are increased,and a quick attenuation of the β-cells appears.Therefore,most of them are transfterred to insulin treatment within 2~3 years.BIAsp30 and BHI30 are better than OADs in improving significantly the control of blood glucose and the function of pancreatic island.The newly diagnosed T2DM patients should have the autoantibody test of pancreatic β cell,and the LADA patients should undergo insulin treatment as soon as possible once the diagnosis is confirmed.