初诊2型糖尿病患者胰岛素泵强化治疗后长期胰岛功能观察

Observation of Insulin Pump Intensive Therapy on Long-time Islet Function in Patients with Type 2 Diabetes Mellitus by Preliminary Diagnosis

目的观察胰岛素泵强化治疗（CSII）对初诊2型糖尿病（T2DM）患者长期胰岛功能的影响。方法收集2000年1月—2008年1月在北京军区总医院内分泌科住院的初诊T2DM患者583例的临床资料,按照患者住院期间治疗方式不同分为CSII组（275例）和口服降糖药物治疗（OHA）组（308例）。2014年1月—2015年6月对两组进行随访,对比两组一般临床资料及胰岛功能相关指标。结果 1初诊时CSII组Hb A1c水平显著高于OHA组（P〈0.05）,随访时稳态模型胰岛素分泌指数（Homa-B）（CP）值高于OHA组、稳态模型胰岛素抵抗指数（Homa-IR）（CP）值低于OHA组,差异有统计学意义（P〈0.05）。2随访时CSII组有18例（6.54%）仅通过生活方式干预即可达长期缓解,而OHA组均需应用药物或胰岛素控制血糖。将CSII组按初诊时糖尿病病程进行分组,不同病程组长期缓解率差异有统计学意义（P〈0.01）,短病程（〈6个月）组长期缓解率显著高于中病程（6~12个月）组与长病程（≥12个月）组（P〈0.05）。结论 CSII可能通过改善胰岛B细胞功能减轻胰岛素抵抗,使部分患者长期获益,且初诊时患者病程越短,长期获益的可能性就越大。

Objective To investigate the effect of insulin pump intensive therapy on the long-time islet function in patients with type 2 diabetes mellitus（ T2DM） by preliminary diagnosis.Methods Clinical data of 583 patients with T2 DM by preliminary diagnosis admitted during January 2000 and January 2008 was collected and the patients were divided into insulin pump intensive therapy group（ group A,n = 275） and oral hypoglycemic agents group（ group B,n =308） according to different therapeutic methods.All the patients were followed up during January 2014 and June 2015,and the general clinical data and related indexes of islet function were compared between the two groups.Results（ 1）In group A,the glycated hemoglobin（ Hb A1c） was higher during preliminary diagnosis（ P〈0.05）,and homeostasis model assessment insulin secretion（ Homa-B） CP value was higher,while the homeostasis model assessment insulin resistance（ HOMA-IR） CP value was lower than those in group B（ P〈0.05）.（ 2） During the follow-up,18 patients（ 6.54%） achieved long-term remission by intervention of life style in group A,while patients in group B achieved blood glucose control using drugs or insulin.Group A was divided into subgroups according to courses of disease,and the differences in long-term remission rates were statistically significant among the subgroups（ P〈0.01）.The long-term remission rate in short course subgroup（ 6 months） was significantly higher than those in the medium（ 6-12 months） and long course（ ≥12 months） subgroups（ P〈0.05）.Conclusion Some patients with T2 DM by preliminary diagnosis can benefit from insulin pump intensive therapy by improving B cell of islet function to relieve insulin resistance,and patients with a shorter course of disease have higher possibility of long-term remission rate.