持续皮下胰岛素注射后延长胰岛素治疗时间对胰岛功能影响的临床观察

Clinical observation of the effect of islet function in extend the duration of insulin treatment after the continuous subcutaneous insulin infusion therapy

目的观察持续皮下胰岛素注射后延长胰岛素治疗时间对伴高血糖的新诊断T2DM患者胰岛β细胞功能的影响。方法根据胰岛素治疗时间,将90例新诊断T2DM患者随机分成2周、3月及5月组,各30例,检测并比较各组治疗前后及治疗结束1年后胰岛β细胞功能。结果各组治疗后血糖均下降,胰岛β细胞功能改善,3月组和5月组△I_（30）/△G_（30）高于2周组[（1.87±0.44）vs（1.95±0.49）vs（1.63±0.51）,P〈0.01]。治疗结束1年后,3月组和5月组缓解率高于2周组（53.3%vs63.3%vs 40.0%,P〈0.05）,5月组高于3月组（P〈0.01）;与非缓解组相比,缓解组HbA在c控制更好[（5.57±0.27）%vs（7.76±0.55）%,P〈0.05],△I_（30）/△G_（30）增加[（1.39±0.78）vs（1.82±0.29）,P〈0.05],胰岛β细胞分泌功能下降更少[（303.71±46.12）vs（200.69±29.42）,P〈0.05]。结论胰岛素强化治疗可改善新诊断T2DM患者胰岛β细胞功能,治疗延长至3~5个月可更好地延缓胰岛β细胞功能减退。

Objective To investigate of the effect of islet β cell function in extend the duration of insulin treatment after the continuous subcutaneous insulin infusion therapy in newly diagnosed type 2diabetic patients（T2DM）.Methods 90 newly diagnosed T2 DM were randomly divided into three groups with intensive insulin therapy for 2 weeks,3 months and 5 months respectively.The islet 8 cell function was measured before and 1 year after treatment,and the differences were compared among each group.Results The plasma glucose was controlled well and the islet 8 cell function was significantly improved in each group after treatment.The ratio value of AI30/AG30 in group of 3 months,5 months were higher than group of 2 weeks[（1.87±0.44） vs（1.95 ± 0.49） vs（1.63 ± 0.51）,P〈0.01].At 1year after treatment,HbA_1 c was significantly lower[（5.57 ± 0.27）%to（7.76 ± 0.55）%,P〈0.05],△I_（30）/△G_（30） was higher[（1.39 ± 0.78） to（1.82 ± 0.29）,P〈0.05]and the descending rate of islet β cell function was slower[（303.71 ± 46.12） vs（200.69 ± 29.42）,P〈0.05]in the remission group than the non-remission group（P〈0.05）.The ratio of remission in group of 3 months and 5 months was higher than 2 weeks（53.3%to 63.3%vs 40.0%,P〈0.05）.Conclusion Intensive insulin therapy can significantly improve the islet 8 cell function of newly diagnosed T2 DM.An appropriate extension for 3~5 months of insulin treatment can further prevent the descending of islet β cell function.