新诊断2型糖尿病患者短期胰岛素泵强化治疗后治疗方案的选择

Treatment regimen selection for newly diagnosed type 2 diabetes after short-term intensive insulin therapy with insulin pump

目的观察胰岛素泵强化治疗对新诊断2型糖尿病的效果,评价强化治疗后降糖治疗方案的转换。方法 72例新诊断2型糖尿病患者接受胰岛素泵强化治疗后分为基础胰岛素组(G组)和常规口服药物组(OAD组),并随访2年。强化治疗前后及随访期检测血糖、胰岛素和糖化血红蛋白(HbA1c)等。结果胰岛素泵强化治疗能有效控制血糖,降低三酰甘油、胆固醇、HOMA-IR,升高HOMA-IS(P<0.05)。G组和OAD组第1年随访平均HbA1c分别为(6.13±0.47)%和(6.21±0.38)%,第2年随访平均HbA1c分别为(6.91±0.57)%和(6.43±0.62)%,HOMA-IR、HOMA-IS均获得长期改善,体质量均无显著增加。结论强化治疗能有效控制血糖、改善胰岛素敏感性和β细胞功能;强化治疗后采用基础胰岛素和口服药物治疗均能获得较理想的血糖控制效果。

Objective To investigate the effects of short-term continuous subcutaneous insulin infusion （CSII） in newly diag-nosed type 2 diabetes mellitus（T2DM ） and to evaluate the treatment regimen conversion after CSII therapy .Methods 72 patients with newly diagnosed T2DM were treated with CSII for 2 weeks .Then they were randomly divided into two groups ：the basal insu-lin group（glargine） and the oral anti-diabetic drug（OAD） group .Both groups were followed up for 2 years .Blood glucose ,insulin and HbA1c were measured before and after CSII and during the 2-year follow-up .Results CSII significantly controlled the glucose levels ,reduced the TG ,TC ,LDL levels and the homeostasis model assessment of insulin resistance （ HOMA-IR） and increased the homeostasis model assessment of insulin secretion （HOMA-IS）（all P〈 0 .05） .During 1-year follow-up ,HbA1c in the glargine group and the OAD group was （6 .13 ± 0 .47）% and（6 .21 ± 0 .38）% respectively .During 2-year follow-up ,the HbA1c values in the two groups were （6 .91 ± 0 .57）% and（6 .43 ± 0 .62）% respectively .T HOMA-IR and HOAM-IS obtained the long tern improve-ment without significant body weight increase .Conclusion Short-term intensive insulin therapy can effectively control the blood glucose ,improve the sensitivity of insulin and the β-cell function ;after CSII ,adopting basic insulin and oral antidiabetic drugs can a-chieve the ideal glycemic control .