2型糖尿病酮症患者消酮期与消酮后期不同胰岛素治疗方式对胰岛功能的影响

Effect of different insulin infusion during and after ketone elimination therapy on beta cell function in patients with diabetic ketosis

目的观察不同胰岛素输注方式对成人酮症起病的糖尿病患者胰岛功能改善的影响。方法 76例以酮症起病的糖尿病患者在消酮期和消酮后期根据胰岛素治疗方式的不同分为A组、B组和C组。观察各组治疗前、治疗后2周及治疗后15周胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能指数(HOMA-β)的变化。结果 3组治疗前均存在IR和一定的胰岛功能损害。治疗后2周及15周后发现,B组HOMA-IR和HOMA-β改善最明显,C组次之,A组最差(P<0.05)。结论 T2DM酮症治疗,持续皮下输注胰岛素优于消酮期静滴胰岛素及消酮后期应用皮下三餐前短/速效、睡前鱼精蛋白锌胰岛素(NPH)方法;同为持续皮下输注胰岛素治疗,消酮期和消酮后期应用基础量联合三餐前追加量的方法,劣于24h实时血糖测定及其相应胰岛素调整的方法。

Objective To evaluate the etiect of different insulin infusion patients with ketosis-onset diabetes. Methods 76 inpatients were divided into three groups：group A,B and C. HOMA-IR and HOMA/3 were used to estimate insulin sensitivity and β-cell function respectively on the visits before treatment,after 2 and 15 weeks. Results Insulin resistance and β-cell dysfunction were found in all before treatments. Group B was improved the most, group C the more than group A after 2 and 15 weeks（P〈0.05）. Conclusion To patients with ketosis-onset diabetes, continuous subcutaneous insulin infusion was better than continuous intravenous insulin infusion in the elimination of ketone period and then muhiple subcutaneous insulin injection in the late cancellation ketone. About insulin pump therapy,the way of amount of additional quantity based united before meals in the elimination of ketone period and the late cancellation ketone was inferior to the way corresponding adjustment of real-time glucose insulin determination all the time.