短期胰岛素泵强化治疗对不同病程2型糖尿病患者胰岛功能的影响

Effect of short-term intensive treatment with insulin pump on beta cell function in patients with different courses of diabetes

目的观察短期胰岛素泵强化治疗对不同病程T2DM患者胰岛功能改善的影响。方法选择不同病程T2DM患者72例,胰岛素泵强化治疗2周。治疗前后行75gOGTT检测血糖、胰岛素及C-P,计算胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)及胰岛素早时相分泌功能指数(ΔI30/ΔG30)。结果强化治疗后各组HOMA-IR差异均有统计学意义(P<0.05)。新诊断T2DM患者(A组)和病程1～5年T2DM患者(B组)治疗前后HOMA-β及ΔI30/ΔG30较治疗前升高,差异有统计学意义(P<0.05)。病程5～10年T2DM患者(C组)HOMA-β较治疗前升高,但差异无统计学意义。结论病程较短的T2DM患者早期使用胰岛素泵强化治疗可改善胰岛功能,包括分泌功能和IR。对于病程长的患者,强化治疗虽不能改善胰岛分泌功能,但理想控制血糖可减轻IR。

Objective To evaluate the effect of insulin pump on pancreatic Ⅱ-cell function in T2DM patients in different stages of diabetes. Methods Seventy-two T2DM patients in different stages were treated with two weeks of continuous subcutaneous insulin infusion （CSII）. 75 gOGTT were performed, and blood glucose, HbA1 c, insulin, and C-peptide were measured before and after CSII. Insulin secretion index （HOMA-β）, insulin resistance index （HOMA-IR）, and early-stage insulin secretion index （△I30/ AC30 ） were calculated before and after treatment. Results After treatment, the differences in HOMA- IR between all groups were statistically significant （P〈0. 05）; HOMA-β and △I30/△C30 were increased significantly in the newly diagnosed T2DM group and the 1-5 year T2DM group （P〈0. 05）; and HOMA-β was increased in the 5-10 year T2DM group, but without statistical significance. Conclusion Short term intensive treatment with insulin pump can improve β-cell function in T2DM patients in the early stage of disease. For those who were with a longer course of diabetes, although the intensive treatment is not able to improve their insulin secretion, the insulin resistance can be alleviated through the optimal glycemic control.