早期胰岛素泵联合西格列汀强化治疗初诊断2型糖尿病的疗效及影响因素分析

Clinical efficacy of early continuous subcutaneous insulin infusion combined with sitagliptin in treatment of patients with primary diagnosed T2DM and its influencing factors

目的探讨初诊断为2型糖尿病(T2DM)患者早期胰岛素泵联合西格列汀(CSII+Sig)强化治疗的疗效及影响因素。方法选取初诊断T2DM患者71例,采用CSII+Sig强化治疗,测定治疗前后3餐前、3餐后2 h及睡前血糖,计算治疗前后空腹血糖(FBG)、餐后2 h血糖(2 h PBG)、糖化血红蛋白(Hb A1c)、餐后2 h C肽与空腹C肽比值(C2/C0)、30 min胰岛素增量与葡萄糖增量比值(△I30/△G30)、胰岛素分泌指数(HOMA?β)、胰岛素抵抗指数(HOMA-IR)、血清内脂素(Visfatin)及胰高血糖素样肽-1(GLP-1)。结果治疗后,3餐前、3餐后2 h及睡前血糖较治疗前均显著降低(P<0.05);单因素分析显示,胰岛素剂量、FBG、2h FBG、Hb A1c、C2/C0、Visfatin、合理饮食以及适量运动与血糖2年控制效果有关(P<0.05);多因素Logistic回归分析显示,合理饮食与适量运动与初诊断T2DM患者血糖2年控制效果具有独立相关性。结论对初诊断T2DM患者,CSII+Sig强化治疗方案可长期控制血糖,合理饮食以及适量运动是血糖2年控制效果的独立影响因素。

Objective To explore the clinical efficacy of early continuous subcutaneous insulin infusion combined with sitagliptin （CSII ＋ Sig） in treatment of patients with primary diag- nosed type 2 diabetes mellitus （T2DM） and analyze its influencing factors. Methods A total of 71 patients with primary diagnosed T2DM were selected and treated with intensive treatment of CSI1 ＋ Sig. The blood glucose 2 hours before and after the 3 meals and before sleep were detected before and after treatment in order to calculate the fasting blood glucose （FBG）, 2 h postprandial blood glucose （2 h PBG）, glycosylated hemoglobin （HbAlc）, the ratio of C peptide 2 hours after meals and fasting C peptide （C2/C0）, the ratio of increased volume of insulin and glucose in 30 rain （△ I30/△ G30）, insulin secretion index （HOMA-β）, homeostasis model assessment-insulin resistance index （HOMA-IR）, serum Visfatin （Visfatin） and glucagon-like peptide-1 （GLP-1）. Results After treatment, blood glucose 2 hours before and after the 3 meals and before sleep de- creased evidently （P 〈 0.05）. Univariate analysis showed that insulin dosage, FBG, 2 h FBG, HbAlc, G2/C0, Visfatin, proper diet and exercises were in close association with the 2-year controlling efficacy of T2DM （P 〈 0.05）, and multivariate Logistic regression analysis indicated that proper diet and exercises were the independent influencing factors for the 2-year controlling efficacy of patients with primary diagnosed T 2 DM . Conclusion For patients with primary diagnosed T2DM, intensive treatment of CSII ＋ Sig can control the blood glucose in a long term, and proper diet and exercises are the independent influencing factors for the 2-year controlling efficacy of patients with primary diagnosed T2DM.