多种胰岛素短期强化治疗对初发2型糖尿病患者血糖及胰岛β细胞功能的影响

Effects of multiform short-term intensive insulin therapies on blood glucose and islet beta cell function of patients with primary type 2 diabetes

目的观察不同类型胰岛素对初发2型糖尿病(T2DM)患者血糖、糖化血红蛋白(HBA1c)及胰岛β细胞功能的影响。方法初发T2DM患者90例随机分为优泌林70/30、优泌乐25、甘精胰岛素治疗组,每组30例。治疗前均检测体质量指数(BMI)、Hb A1c、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C),并行口服葡萄糖耐量试验(OGTT),在0、30、60、120、180 min测定血糖、胰岛素,使用稳态模型评估胰岛素抵抗程度、胰岛β细胞功能。每组患者均治疗12周,重新OGTT试验测量并计算上述指标,对比每组患者试验前后上述指标组间差异。血糖及HBA1c达标者观察血糖缓解率。结果3组治疗12周后血糖、HBA1c、HOMA-IR均较治疗前明显下降,HOMA-β明显升高,甘精胰岛素组BMI及空腹血糖低于其他2组(P<0.05),优泌乐25组和甘精胰岛素组HOMA-β高于优泌林70/30组(P<0.05),甘精胰岛素低血糖发生率明显低于其他2组。3组血糖缓解率无差异。结论预混胰岛素和长效胰岛素类似物均能有效降低初发T2DM血糖、减轻胰岛素抵抗、改善胰岛β细胞功能,甘精胰岛素联合口服降糖药效果与预混胰岛素类似。

Objective To investigate the effects of different types of insulin on blood glucose,glycosylated hemoglobin（ HBA1c） and islet beta cell function of patients with primary type 2diabetes（ T2DM）. Methods Ninety patients with primary type 2 diabetes were randomly divided into humulin 70 /30 group,humalog 25 group and glargine group,30 cases in each group. Serum levels of HBA1 c,triglyceride（ TG）,total cholesterol（ TC）,low-density lipoprotein cholesterol（ LDL-C）and body mass index（ BMI） were detected in all patients. Venous blood samples were collected at 0,30,60,120,180 min,and 75 g oral glucose tolerance test was performed to measure glucose and insulin. Steady state model was used to assess the degree of insulin resistance and islet beta cell function. OGTT test was performed again and all indexes were calculated after 12 weeks. Patients with qualified blood glucose and HBA1 c were followed-up for observation of blood glucose remission rate.Results After treatment,blood glucose,HBA1 c and HOMA-IR decreased,while HOMA-β increased significantly in three groups. BMI,fasting plasma glucose and incidence rate of hypoglycaemia in glargine group were significantly lower than the other two groups（ P〈0. 05）. HOMA-β in humalog 25 group and glargine group was significantly higher than humulin 70 /30 group. There was no significant difference in blood glucose remission rate among three groups. Conclusion Premixed insulin and long-acting insulin analogue can effectively control glucose level,reduce insulin resistance and improve the function of islet beta cells. Effect of glargine combined with oral medications is similar to premixed insulin.