合并心脏病的2型糖尿病患者胰岛素泵强化治疗初探

Preliminary Study for Continuous Subcutaneous Insulin Infusion in Type 2 Diabetes Patients With Heart Diseases

目的：评估14天胰岛素泵强化治疗合并心脏病的2型糖尿病（病程小于5年）的疗效及安全性。方法：既往有心脏病史的2型糖尿病患者22例，平均年龄（48.15±9.80）岁，男女比例20：2。既往未行系统降糖治疗，入院后给予14天胰岛素泵强化降糖治疗，比较治疗前后的血糖水平、胰岛功能、胰岛素敏感性。结果：胰岛素泵强化治疗后，血糖水平显著下降，空腹血糖及馒头餐试验30、60、120分钟血糖差异均有统计学意义（P〈0.001）；60分钟、120分钟C肽水平提高[2.73（1.05-7.05）ng/ml vs 3.84（1.22-63.39）ng/ml，3.34（1.42-9.61） ng/ml vs 6.27（0.93-47.39）ng/ml，P均=0.004]；胰岛素敏感性（IAI）改善（-1.89±0.29 vs -1.70±0.31，P=0.008）。治疗后仅依靠饮食控制和规律运动血糖即可达标者5例（22.73%），继续使用降糖药物治疗者17例（77.27%）；平均随访（12.4±8.5）个月（1-28个月），5例停泵患者仍有4例未用任何降糖药物治疗，血糖控制良好，另1例因饮食控制差，血糖升高，2个月后行胰岛素治疗，余17例维持口服降糖药物治疗。结论：合并心脏病的2型糖尿病患者可行短期的胰岛素泵强化降糖治疗。该治疗方式可快速解除高糖毒性，改善胰岛素敏感性。部分患者停用降糖药物，减轻其过多的用药负担。

Objectives： To evaluate the effect and safety of 14-day continuous subcutaneous insulin infusion （CSII） in type 2 diabetes patients with heart diseases.Methods： A total of 22 consecutive type 2 diabetes patients （history ≤ 5 years） with heart diseases treated in our hospital from 2011-03 to 2013-08 were studied. There were 20 male, and the with the mean age of patieuts （48.15 ± 9.80） years, all patients without standard hypoglycemic treatment before admission. The patients received 14-day CSII for enhanced treatment and the blood glucose level, insulin function and insulin sensitivity were compared before and after the treatment.Results： After CSII treatment, the blood glucose level was obviously decreased, fasting blood glucose （FBG） and postprandial blood glucose at 30, 60 and 120 min were improved, all P〈0.001. The C peptide level was higher at 60 and 120 min alter treatweut as 2.73 （1.05-7.05）ng/ml vs 3.84 （1.22-63.39）ng/ml, P=0.004 and 3.34 （1.42-9.61）ng/ml vs 6.27 （0.93-47.39）ng/ml, P=0.004. The insulin sensitivity was improved as -1.89 ± 0.29 vs -1.70±0.31, P=0.008. With CSII treatment, there were 22.73% patients （5/22） at remission by controlling the diet and excise and 77.27% （17/22） with continuing medication. The patients were followed-up for （12.4 ± 8.5） months, there were 4/5 patients with euglycemia, 1/5 with increase blood sugar and received medication at 2 months after discharge, the rest 17 patients remained oral hypoglycemic medication.Conclusion： CSII may quickly relieve glucotoxicity and improve insulin sensitivity in type 2 diabetes patients with heart diseases. Some patients may alleviate drug burden in clinical practice.