短期胰岛素强化治疗诱导初诊2型糖尿病患者血糖长期良好控制的临床试验

Induction of long-term good glycemic control in newly diagnosed type 2 diabetic patients by transient intensive insulin treatment

目的 探讨短期胰岛素强化治疗对改善 2型糖尿病患者的胰岛 β细胞功能和血糖控制的影响。 方法 采用自身前后对照 ,观察 2 2例新诊断 2型糖尿病患者接受 2周短期胰岛素泵治疗前后胰岛 β细胞对血糖刺激的胰岛素第一时相分泌的变化 ,探讨胰岛 β细胞功能及其影响因素和随访短期胰岛素强化治疗对 (不采用任何降糖药物 )长期血糖控制的影响。 结果 治疗 2周后 ,治疗前后静脉葡萄糖试验中胰岛素曲线下面积、胰岛素峰值、胰岛素峰值差值、胰岛素与血糖总量比值、胰岛素与血糖增量比值及HomaB指数明显升高 (P <0 .0 5 ) ;HomaA指数明显下降 (P <0 .0 5 )。治疗前后胰岛素峰值呈正相关 (r=0 .5 2 1,P =0 .0 13)。有 15例患者仅采用饮食控制 ,平均随访 6个月时糖化血红蛋白为 5 .97%± 0 .5 9% ,空腹血糖为 ( 6 .3± 1.1)mmol/L ,OGTT 2h血糖为 ( 7.8± 2 .4 )mmol/L ,空腹胰岛素为 ( 9±4 ) μU/ml,OGTT 2h胰岛素为 ( 2 0± 5 ) μU/ml。 结论 短期强化胰岛素治疗可以显著恢复代表胰岛 β细胞功能的血糖刺激的胰岛素第一时相分泌 ,使患者的糖尿病回到 2型糖尿病自然病程的更早期阶段 ,部分患者不用任何药物 。

Objective To study the impact of short term intensive insulin treatment on β cell function and long term glycemic control in newly diagnosed type 2 diabetic patients. Methods Twenty two newly diagnosed type 2 diabetic patients were treated with continuous subcutaneous insulin infusion (CSII) for 2 weeks and their β cell function were assessed before and after the insulin treatment by intravenous glucose tolerance test. After the treatment, all patients were followed up for their glycemic control level. Results Two weeks after the treatment, the AUC 0 10 INS, the insulin peak, the increment of the insulin peak(ΔINS), the ratio of total amount insulin to total amount glucose, the ratio of ΔINS/ΔG and Homa B were significantly increased ( P <0.05). Homa A was also significantly decreased ( P <0.05). The insulin peak before and after the treatment were positively correlated ( r=0.521,P =0.013). Fifteen patients were followed up for an average of 6 months with mean HbA 1c of 5.97±0.59%, fasting plasma glucose levels of 6.34±1.07 mmol/L, 2 h OGTT plasma glucose levels of 7.81±2.41 mmol/L, fasting insulin levels of 8.63±4.43 μU/ml and 2 h OGTT insulin levels of 19.85±5.33 μU/ml at six month follow up point. Conclusion Short term intensive insulin treatment can effectively induce long term good glycemic control without medication by improving the β cell function as well as decreasing the insulin resistance and restoring the first phase of insulin secretion via eliminating the glucose toxicity. The patients might be brought back in a early time along the natural history of type 2 diabetes to a stage where non pharmacological therapys are still quite efficacious in term of blood glucose control. This suggests that the transient intensive insulin treatment might be therapys used as primary approach in the management of newly diagnosed type 2 diabetes patients.