新诊断2型糖尿病患者胰岛素强化治疗后三种不同维持方案疗效及安全性的研究

The clinical efficacy and safety of three kinds of maintenance regimens after intensive insulin therapy in patients with newly diagnosed T2DM

目的探讨新诊断T2DM患者胰岛素强化治疗后应用甘精胰岛素、门冬胰岛素30及格列齐特三种维持治疗方案的疗效及安全性.方法选取2016年4月至2018年4月于我院内分泌科收治的新诊断T2DM患者195例,在胰岛素强化治疗后随机分别给予甘精胰岛素(Gla组)、门冬胰岛素30(Asp组)及格列齐特(Gli组)维持治疗,每组各65例.比较各组维持治疗前后BMI、血糖、血脂、胰岛β细胞功能指数(HOMA-β)、急性期胰岛素分泌反应(AIR)、胰岛素抵抗指数(HOMA-IR)及低血糖发生率.结果各组维持治疗后BMI、FBG、HbA1c、TG、TC、HDL-C及HOMA-IR水平比较,差异无统计学意义(P>0.05),HOMA-β和AIR水平优于治疗前(P<0.05),Gla、Asp组HOMA-β和AIR水平优于Gli组(P<0.05);Gla、Asp、Gli组低血糖发生率分别为0(0.00%)、1(1.54%)、0(0.00%),差异无统计学意义(χ2=1.05,P>0.05).结论新诊断T2DM患者胰岛素强化治疗后继续行胰岛素的维持治疗方案,可有效保护胰岛β细胞功能,缓解IR及病情进展,安全性较好,治疗效果优于格列齐特维持方案.

Objective To investigate the clinical efficacy a nd safety of insulin glargine,insulin aspar tate 30 and gliclazide for maintenance regimens after intensive insulin therapy in patients with newly diagnosed type 2 diabetes(T2DM).Methods 195 inpatients with newly diagnosed T2DM receiving intensive insulin therapy from April 2016 to April 2018 in our hospital were randomly divided into 3 groups for maintenance therapy:insulin glargine group(Gia,77=65),insulin aspartate 30 group(Asp,n=65)and gliclazide group(Gli,n=65).BMI,glycemic index,blood lipid index,AIR,HOME-IR and HOMA-p before and after treatment and the hypoglycemia incidence among three groups were compared.Results There was no significant difference in the levels of BMI,FBG,HbAiC,TG,TC,HDL-C and HOMA-IR among the three groups(F>0.05).The index of HOMA-p and AIR in each group were significantly improved(P<0.05).The improvemenl of HOMA-β and AIR in Gia group and Asp group were better than that in Gli group(P<0.05).The hypoglycemia incidences in Gia group 0(0.00%),Asp group 1(1.54%)and Gli group 0(0.00%)had no significant difference(x2=1.05,P>0.05).Conclusion Compared with gliclazide for maintenance treatment,insulin regimens after intensive insulin therapy in newly diagnosed T2DM patients can efficiently protect the pancreatic p cell function,improve insulin resistance and delay the disease progression with reliable safety.