初发2型糖尿病患者强化胰岛素治疗与多次胰岛素注射疗效对比研究

Efficacy of intensive insulin therapy and multiple insulin injections on early-onset type 2 diabetes

目的:探讨对于初发2型糖尿病患者,短期胰岛素强化治疗及多次皮下注射对胰岛β细胞及血糖控制的影响,并探讨其机制。方法:回顾性分析2011～2012年在本院住院的58例初诊2型糖尿病患者,经胰岛素泵强化治疗(CSⅡ)和多次皮下注射胰岛素(MSⅡ)两种方法,通过自身前后对比和组间比较,分析高血糖刺激的胰岛素第一时相的分泌、糖化血红蛋白含量、糖耐量实验(OGTT)、体重指数(BMI)等指标。结果:两组患者之间及与自身治疗前比较,空腹血糖(FPG)、餐后2小时血糖(2hPG)下降,平均血糖达标天数减少,均有统计学意义(P<0.05),两组治疗前比较,血中空腹C肽产生无统计学差异,各自治疗前后比较,差异有统计学意义(P<0.05);糖化血红蛋白(HbAc1)与体重指数治疗前后自身对比及组间比较,差异无统计学意义(P>0.05)。结论:初诊糖尿病患者短期胰岛素强化治疗,可以显著改善代表胰岛β细胞功能的胰岛素第一时相分泌,且血糖控制的更平稳,发生低血糖不良反应比例较少,使糖尿病患者胰岛素功能可以恢复到糖尿病病程的更早期阶段,这可能是通过减少β细胞毒性的机制实现的。

Objective：To investigate the efficacy and the mechanism of intensive insulin therapy and multiple insulin injections on treating early-onset type 2diabetes.Methods：Clinical data of 58cases with early-onset type 2diabetes admitted from 2011to 2012were retrospectively analyzed.They were treated by Insulin pump intensive treatment（CSⅡgroup）or continuous subcutaneous insulin infusion（MSⅡ group）.Fasting plasma glucose（FPG）,2hPG,fasting plasma C-peptide in plasma,BMI,OGTT before and after the treatment were measured and compared between CSⅡ and MSⅡ groups.Results：After treatments,FPG,2hPG,the time for normal glucose were decreased significantly（P0.05）,and the differences in these indexes were significant between two groups（P0.05）.Before the treatment,there was no significant difference in fasting plasma C-peptide between two groups,but the difference was significant after treatment（P0.05）.After treatment,there was no significant changes in HbAc1and BMI,and the differences were not significant between two groups（P0.05）.Conclusions：Short-term insulin treatment can significantly improve insulin secretion at the first phase,which is more stable and of few side reactions such as hypoglycemia.It may be associated with reduce toxicity of β cells.