门冬胰岛素30和预混人胰岛素30R对非初发2型糖尿病胰岛功能和胰岛素敏感性的影响

Effect of insulin aspart 30 and premixed human insulin 30R on islet function and insulin sensitivity in patients with non- onset type 2 diabetes mellitus

目的观察门冬胰岛素30(ASP 30)和预混人胰岛素30R(PHI 30R)治疗非初发2型糖尿病(T2DM)的疗效及其对胰岛β细胞功能及胰岛素敏感性的影响,为T2DM优化治疗方案提供依据。方法选择60例非初发的T2DM患者,随机分为两组,分别给予ASP 30和PHI 30R治疗,剂量稳定后维持治疗3个月。记录治疗前后体重指数(BMI),测定治疗前后的空腹血糖(FPG)、馒头餐后2 h血糖(2hPBG)、糖化血红蛋白(HbA1c)、空腹C肽(FCP)及馒头餐后2 h C肽(2hCP)。计算胰岛素抵抗指数(HOMA-IR)和胰岛β细胞指数(HOMA-β)评估胰岛素敏感性和胰岛功能。结果治疗后,ASP 30组FPG(7.28±1.65)mmol/L、2hPBG(9.39±1.31)mmol/L、HbA1c(7.18±0.97)%、HOMA-IR(0.49±0.25)均较治疗前[(9.34±3.72)mmol/L、(13.26±3.30)mmol/L、(9.22±1.95)%、(0.85±0.60)]明显下降(P<0.05);同样PHI 30R组FPG(7.90±2.84 mmol/L)、2hPBG(10.87±2.78mmol/L)、HbA1c(7.02±1.26)%、HOMA-IR(0.65±0.31)也较治疗前[(9.11±2.91)mmol/L、(12.58±3.23)mmol/L、(8.81±1.66)%、(0.93±0.39)]明显下降(P<0.05);但是两组的FCP、2hCP、HOMA-β较治疗前无明显变化(P>0.05)。组间比较显示,ASP 30组治疗后的2hPBG(9.39±1.31 mmol/L)更低于PHI 30R组(10.87±2.78 mmol/L)(P<0.05),而其他指标的差异无显著性意义(P>0.05)。结论 ASP 30对餐后血糖的控制优于PHI 30R。ASP 30和PHI 30R均能明显改善非初发T2DM者胰岛素的敏感性,但ASP 30并不占优势,而二者均未能改善胰岛功能。

Objective To observe effect in non - onset type 2 diabetes mellitus （T2DM） ,and to provide accordance for selecting optimization of insulin therapy in patients with T2DM. Methods Sixty patients with non - onset T2DM were enrolled to this study. Blood samples were collected to test fasting blood glucose（ FPG）, glycosylated hemoglobin（ HbAlc）, fasting C - peptide （ FCP）, Postprandial 2 - hour blood glucose （2hPBG） and postprandial 2 - hour C - peptide （2hCP）. Pancreatic 13 cell index（ HOMA - β）, Insulin resistance index（ HOMA -IR） were calculated. After the original treatment was suspended, they were divided into two groups with twice - daily insulin aspart 30（ ASP 30） or premixed human insulin 30R （ PHI 30R） subcutaneous injection. It was allowed to be combined with oral hypoglycemic agents （metformin or acarbose）.The treatment was proceeding at least 3 months. The indexes were measured again. Results FPG, 2hPBG, HbAlc, HOMA - IR in ASP 30 group after treatment decreased significantly compared with before treatment [ （ 7.28 ± 1.65 ） vs （9.34±3.72） mmol/L, （9.39±1.31） vs （13.26±3.30） mmol/L, （7.18±0.97） vs （9.22±1.95） %, （0.49± 0. 25 ） vs （0.85 ± 0. 60） ] （P 〈 0. 05 ）. Similarly, FPG, 2hPBG, HbA1 c, HOMA - IR in PHI 30R group after treatment also decreased significantly compared with before treatment [ （7.90 ± 2.84） vs （9.11 ± 2.91 ） mmol / L, （ 10.87 ± 2.78） vs （12.58 ±3.23） mmol/L, （7.02±1.26） vs （8.81 ±1.66）%, （0.65 ±0.31） vs （0.93 ±0.39）] （P〈 0. 05 ）. But FCP, 2hCP and HOMA -β did not have markedly change after treatment in both groups compared with before treatment （ P 〉 0.05 ）. Comparison between groups showed that 2hPBG in ASP 30 groups after treatment （ 9.39 ± 1.31 ） mmol / L is lower than in PHI 30R group （ 10.87 ± 2.78 ） mmol / L （ P 〈 0.05 ）, while other indicators were no difference （P〉0.05）. Condusion Compared with PHI 30R, the dominant of ASP 30 is the control in postprandial 2 - hour blood glucose. The insulin resistance was significantly improve after insulin treatment, but ASP 30 is not predominant.