2型糖尿病治疗中胰岛素联合维生素D的应用效果及安全性分析

Effect and safety of insulin combined with vitamin D on type 2 diabetes mellitus

目的探究2型糖尿病(T2DM)治疗中胰岛素联合维生素D的应用效果及安全性。方法选取2017年1月至2019年6月内蒙古包钢医院收治的136例T2DM患者。按照随机数字表法分为观察组和对照组,各68例。对照组采用动态血糖监测系统联合胰岛素泵治疗;观察组在对照组基础上加用阿法骨化醇软胶囊治疗。2组疗程均为3个月。观察2组治疗后血糖控制、维生素D缺乏情况、胰岛素水平及敏感度、炎性因子(白细胞介素6、肿瘤坏死因子α)水平和不良反应发生情况。结果治疗后2组空腹血糖、餐后2 h血糖、糖化血红蛋白均下降,但组间比较差异均无统计学意义(均P>0.05)。治疗后2组空腹胰岛素、稳态模型胰岛素抵抗指数均较治疗前下降,且观察组低于对照组[(7.2±2.1)mIU/L比(9.9±1.1)mIU/L、(2.3±0.3)比(3.1±0.4)];稳态模型胰岛β细胞功能指数均较治疗前升高,且观察组高于对照组[(80±7)比(65±7)],差异均有统计学意义(均P<0.05)。治疗后2组骨密度水平均较治疗前升高,且观察组高于对照组;Ⅰ型前胶原氨基端前肽均较治疗前降低,且观察组低于对照组,差异均有统计学意义(均P<0.05)。治疗后2组血清白细胞介素6、肿瘤坏死因子α水平均较治疗前下降,且观察组低于对照组,差异均有统计学意义(均P<0.05)。2组总不良反应发生率比较差异无统计学意义(P>0.05)。结论采用胰岛素联合维生素D治疗T2DM患者能从调节炎症、胰岛素敏感性及胰岛素抵抗等多方面对胰岛发挥保护作用,还能改善患者骨质疏松状况,是一种安全有效的治疗方法。

Objective To investigate the effect and safety of insulin combined with vitamin D treating type 2 diabetes mellitus(T2DM).Methods A total of 136 patients with T2DM admitted to Inner Mongolia Baogang Hospital from January 2017 to June 2019 were randomly divided into the observation group and the control group,with 68 patients in each group.The control group was treated with insulin and observation group was treated with insulin plus vitamin D.The course of treatment in both groups were 3 months.The blood glucose,vitamin D deficiency,insulin level and sensitivity,inflammatory factors(interleukin-6,tumor necrosis factor-α)and adverse reactions after treatment were observed.Results After treatment,the fasting blood glucose,2 h postprandial blood glucose and glycosylated hemoglobin in 2 groups decreased than those before treatment;there were no significant difference between the two groups(all P>0.05).After treatment,fasting insulin and homeostasis model assessment insulin resistance index in the two groups were lower than those before treatment,and those in observation group was lower than those in control group[(7.2±2.1)mIU/L vs(9.9±1.1)mIU/L,(2.3±0.3)vs(3.1±0.4)];β-cell function index in the steady-state model was higher than that before treatment,and observation group was higher than control group[(80±7)vs(65±7)](all P<0.05).After treatment,the bone mineral density level of the two groups were higher than that before treatment;observation group was higher than control group;the procollagen I M-terminal propeptide was lower than that before treatment;the observation group was lower than the control group(all P<0.05).After treatment,the levels of inflammatory factors interleukin-6 and tumor necrosis factor-αdecreased;the observation group was lower than the control group(all P<0.05).There was no significant difference in total adverse reactions(all P>0.05).Conclusion The combination of insulin and vitamin D in patients with T2DM can improve the islets function from inflammation regulation,insulin sensitivity,insulin resistance and relieve osteoporosis.