皮下注射胰岛素联合口服二甲双胍治疗儿童2型糖尿病的回顾性分析

Clinical effect of subcutaneous insulin injection combined with metformin for type 2 diabetes mellitus in children

目的:探讨皮下注射胰岛素联合口服二甲双胍治疗儿童2型糖尿病(type 2 diabetes mellitus,T2DM)的临床疗效.方法:回顾性分析2012-08/2013-08在我院经盐酸二甲双胍缓释片+皮下注射速效门冬胰岛素治疗的35例T2DM儿童(观察组)和同期经盐酸二甲双胍缓释片治疗的35例儿童(对照组)的临床病例资料,比较两组患儿治疗前后空腹血糖(fasting plasma glucose,FPG)、餐后2 h血糖(2 hour plasma glucose,2hPG)、总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、高密度脂蛋白胆固醇(high density lipoprotein,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein,LDL-C)、糖化血红蛋白(glycosylated hemoglobin,HbAlC)、空腹胰岛素(fasting insulin,FINS)、胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)、空腹C肽(fasting c-peptide,F-CP)和胰岛素分泌指数(homeostasis model assessment,Homa-β)等指标的变化.结果:两组患儿治疗后FPG、2hPG水平均明显下降(5.52 mmol/L±0.77 mmol/L vs 10.34 mmol/L±3.26 mmol/L、6.86 mmol/L±1.35 mmol/L vs 15.17 mmol/L±3.89 mmol/L,5.76 mmol/L±0.69 mmol/L vs 9.89 mmol/L±3.43 mmol/L、7.02 mmol/L±1.08 mmol/L vs 14.33 mmol/L±2.82 mmol/L),与治疗前比较,差异具有统计学意义(P<0.05);两组间治疗后FPG、2hPG水平比较,差异无统计学意义(P>0.05);两组患儿治疗后TG、LDL-C、HbAlC及BMI水平均明显下降(1.92 mmol/L±0.91 mmol/L vs 4.06 mmol/L±1.09 mmol/L、1.12 mmol/L±0.69 mmol/L vs 1.22 mmol/L±0.60 mmol/L、4.81%±1.30%vs 8.22%±1.73%、25.13 kg/m2±2.78 kg/m2 vs 27.95 kg/m2±1.79 kg/m2,1.89 mmol/L±1.21 mmol/L vs 3.8 mmol/L±1.33 mmol/L、1.31 mmol/L±0.49 mmol/L vs 1.20 mmol/L±0.59 mmol/L、4.08%±1.51%vs 7.79%±2.83%、24.76 kg/m2±2.61 kg/m2 vs 28.62 kg/m2±1.68 kg/m2),与治疗前比较,差异具有统计学意义(P<0.05或0.01);两组患儿治疗后TC和HDL-C水平均无明显变化,与治疗前比较,差异无统计学意义(P>0.05);两组患儿治疗后TC、TG、HDL-C、LDL-C、HbAlC及BMI水平比较,差异无统计学意义(P>0.05);两组患儿治疗后FINS、F-CP和Homa-β水平明显升高(18.32 mU/L±3.81 mU/L vs 13.30 mU/L±4.13 mU/L、5.95 mmol/L±1.26 mmol/L vs 2.72 mmol/L±1.30 mmol/L、85.35 mU/L±62.22 mU/L vs 23.57 mU/L±16.81 mU/L,15.58 mU/L±2.62 mU/L vs 12.97 mU/L±3.96 mU/L、3.02 mmol/L±1.52 mmol/L vs 2.63 mmol/L±1.34 mmol/L、63.88±53.71 vs 21.35±17.92),HOMA-IR水平明显下降(1.19±0.37 vs 1.91±0.56,1.55±0.33 vs 1.86±0.57),与治疗前比较,差异具有统计学意义(P<0.05或0.01);观察组患儿治疗后FINS、F-CP和Homa-β水平明显高于对照组(18.32 mU/L±3.81 mU/L vs 15.58 mU/L±2.62 mU/L、5.95 mmol/L±1.26 mmol/L vs 3.02 mmol/L±1.52 mmol/L、85.35±62.22 vs 63.88±53.71),HOMA-IR水平明显低于对照组(1.19±0.37 vs 1.55±0.33),差异具有统计学意义(P<0.05).结论:皮下注射胰岛素联合口服二甲双胍治疗T2DM能够有效改善儿童糖尿病相关指标和胰岛功能,临床疗效显著.

AIM： To explore the clinical effect of subcutaneous insulin injection combined with metformin for type 2 diabetes mellitus （T2DM） in children. METHODS： Seventy children with T2DM were analyzed retrospectively. They were randomly divided into two groups： a control group and an experiment group. The control group was treated with metformin hydrochloride sustained- release tablets, and the experiment group was treated by subcutaneous injection insulin on the basis of treatment with metformin hydrochloride sustained-release tablets. FPG, 2hPG, TC, TG, HDL-C, LDL-C, HbA1C, FINS, HOMA-IR, F-CP and Homa-（3 were compared between the two groups. RESULTS： Post-treatment levels of FPG and 2hPG were lower than pretreatment values （5.52mmol/L ± 0.77 mmol/L vs 10.34 mmol/L ± 3.26 mmol/L, 6.86 mmol/L ± 1.35 mmol/L vs 15.17 mmol/L ± 3.89 mmol/L, 5.76 mmol/L ± 0.69 mmol/L vs 9.89 mmol/L ± 3.43 mmol/L, 7.02 mmol/L ± 1.08 mmol/L vs 14.33 mmol/L ± 2.82 mmol/L, P 〈 0.05 for all）. There were no significant differences in FPG and 2hPG between the two groups （P 〉 0.05 for all）. Post-treatment levels of TG, LDL-C, HbA1C and BMI were significantly lower than pretreatment values （1.92 mmol/L ± 0.91 mmoI/L vs 4.06 mmoI/L ± 1.09 mmol/L, 1.12 mmol/L ± 0.69 mmol/L vs 1.22 mmol/L ± 0.60 mmol/L, 4.81 mmol/L ± 1.30 mmol/L vs 8.22% ± 1.73%; 25.13 kg/m2 ± 2.78 kg/m2 vs 27.95 kg/m2 ± 1.79 kg/m2, 1.89 retool/ L ± 1.21 mmol/L vs 3.8 mmol/L ± 1.33 mmol/L, 1.31 mmol/L ± 0.49 mmol/L vs 1.20 mmol/L ± 0.59 mmol/L, 4.08% ± 1.51% vs 7.79% ± 2.83%, 24.76 kg/m2 ± 2.61 kg/m2 vs 28.62 kg/m2 ± 1.68 kg/m2, P 〈 0.05 or 0.01 for all）. There were no significant differences in the levels of TC, HDL-C, TG, HDL-C, LDL-C, HbA1C or BMI between before and after treatment in both groups （P 〉 0.05 for all）. Post-treatment levels of FINS, F-CP and Homa-6 were significantly higher than pre-treatment values （18.32 mU/L ± 3.81 mU/L vs 13.30 mU/L ±4. 13 mU/L, 5.95 mU/L ± 1.26 mmol/L vs 2.72 mmol/L ± 1.30 mmol/L, 85.35 mU/L ± 62.22 mU/L vs 23.57 mU/L ± 16.81 mU/L, 15.58 mU/L ± 2.62 mU/L vs 12.97 mU/L ± 3.96 mU/L, 3.02 mmol/L ± 1.52 mmol/L vs 2.63 mmol/L ± 1.34 mmol/L, 63.88 ± 53.71 vs 21.35 ± 17.92, P 〈 0.05 or 0.01 for all）, while the levels of HOMA-IR were significantly lower after treatment than before treatment （1.19 ± 0.37 vs 1.91 ± 0.56, 1.55 ± 0.33 vs 1.86 ± 0.57, P 〈 0.05 or 0.01 for all）. The levels of FINS, F-CP and Homa-β in the experiment group were significantly higher than those in the control group （18.32 mU/L ± 3.81 mU/L vs 15.58 mU/L ± 2.62 mU/L, 5.95 mmol/ L ± 1.26 mmol/L vs 3.02 mmol/L ± 1.52 retool/L, 85.35 ± 62.22 vs 63.88 ± 53.71, P 〈 0.05 for all）, while the level of HOMAqR was significantly lower than the control group （1.19 ± 0.37 vs 1.55 ± 0.33, P 〈 0.05）.CONCLUSION： Subcutaneous insulin injection combined with metformin can improve serum indices and islet function in T2DM children.