短期胰岛素强化治疗对新诊断2型糖尿病患者α细胞功能的影响

Effects of short-term intensive insulin therapy onα-cell function in patients with newly diagnosed type 2 diabetes

目的探讨12周胰岛素强化治疗对新诊断的2型糖尿病患者α细胞功能的影响。方法纳入108例新诊断的2型糖尿病患者,随机1∶1分为观察组和对照组。观察组接受胰岛素强化治疗,对照组接受口服降糖药治疗。于治疗前、治疗12周和12个月时对患者基本信息、血脂随访,随访期间进行葡萄糖耐量试验,分别在0、30和120 min测定胰高血糖素、胰岛素原、C肽和血糖水平变化。结果观察组在治疗12周和12个月时,与基线相比,0、30和120 min时胰高血糖素水平和胰岛素原/C肽显著降低(P<0.001),△CP30/△G30和△CP120/△G120显著增高(P<0.001)。与常规口服降糖药治疗方法相比,胰岛素强化治疗在12周与12个月时,0、30和120分钟时胰高血糖素水平和胰岛素原/C肽更低(P<0.001),△CP30/△G30更高(P<0.001);而△CP120/△G12012周时更高(P<0.001),12个月时差异无统计学意义(P=1.000)。与对照组相比,观察组在12周和12个月时达到目标血糖(糖化血红蛋白<7%)患者比例较高(P<0.001)。观察组在12周和12个月时三酰甘油和血清总胆固醇水平较低(P<0.05)。12个月后,观察组的患者病情缓解率26.9%高于对照组的3.9%(P<0.001)。结论短期胰岛素强化治疗有助于改善新诊断2型糖尿病患者的α细胞和β细胞功能,从而更好的进行长期代谢控制,β细胞分泌减少和伴随的α细胞功能障碍都可能参与2型糖尿病的发病机制。

Objective To investigate the effects of 12-week intensive insulin therapy on alpha cell function in patients with newly diagnosed type 2 diabetes(T2DM).Methods A total of 108 patients with newly diagnosed T2DM were enrolled in the stduy,who were randomly divided into observation group and control group,with 54 cases in each group.The patients in observation group were treated by intensive insulin therapy,however,the patients in control group were treated by conventional oral hypoglycemic agents.The basic information,and the levels of lipids,glucagon,proinsulin,C-peptide(CP)before treatment,at 12w and 12m after treatment were observed and comapred between the two groups.Moreover the levels of glucagon,proinsulin,CP and blood glucose were detected at 0min,30min and 120min were measured.Results At 12w and 12m after treatment,the levels of glucagon,proinsulin,CP at 0min,30min and 120m were significantly lower than those of baseline(P<0.01),however,the levels of CP30/G30 and CP120/G120 were significantly increased(P<0.01),moreover,the levels of glucagon,proinsulin,CP in observation group were significantly lower than those in control group(P<0.01),however,the levels of CP30/G30 in observation group were significantly higher than those in control group(P<0.01),moreover,the levels of CP120/G120 in observation group were significantly increased,but,there were no significant differences at 12m after treatment between the two groups(P>0.05).The proportion of patients who reached the target blood glucose(glycated hemoglobin<7%)at 12 weeks and 12 months in observation group was significantly higher than that in control group(P<0.01).Moreover the levels of triglyceride and serum total cholesterol at 12w and 12m after treatment were significantly decreased in observation group(P<0.05).After 12-month treatment,the remission rate in observation group was 26.9%,which was significantly higher than that(3.9%)in control group(P<0.01).Conclusion The short-term intensive insulin therapy is helpful to improveβ-cell andα-cell function in patients with newly diagnosed T2DM diabetes.Moreover the decrease ofβ-cell secretion and concomitantα-cell dysfunction may be involved in the pathogenesis of T2DM.