短期持续胰岛素输注治疗对初诊2型糖尿病患者胰岛β细胞功能的影响

The effects of short-term continuous subcutaneous insulin infusion treatment on beta-cell function in newly diagnosed type 2 diabetic patients

目的 观察短期持续性皮下胰岛素输注 (CSII)治疗对伴明显高血糖的初诊 2型糖尿病患者的降糖效果和胰岛 β细胞功能的影响。 方法 对空腹血糖 >11.1mmol/L的 36例初诊 2型糖尿病患者进行为期 2周的CSII强化治疗 ,分析比较其治疗前后空腹及餐后 2h血糖、糖化血红蛋白A1C、静脉葡萄糖耐量 (IVGTT)试验时胰岛素分泌第一时相和胰岛素及C肽曲线下面积、空腹血浆胰岛素原、胰岛素原与胰岛素比值和由Homa模型计算的Homaβ、HomaIR等。血浆胰岛素、C肽、胰岛素原浓度均用放免法测定。 结果 2周的CSII治疗显示出快速稳定的降血糖效果。其中 35例患者的空腹、餐后 2h血糖分别于治疗后 ( 2 .7± 1.9)d、( 8.5± 3.5 )d达到良好控制 ,且未见明显低血糖。胰岛 β细胞功能在治疗后获得显著改善 :静脉注射葡萄糖后 10min内出现了明显增加的胰岛素、C肽分泌相 ,更有部分患者可以见到典型的胰岛素第一时相分泌尖峰 ,胰岛素、C肽曲线下面积和由Homa模型计算的Homaβ值均较治疗前明显提高 ,而胰岛素原、胰岛素原与胰岛素比值则较治疗前明显下降。反映胰岛素抵抗的HomaIR也较治疗前明显降低。 结论 对伴明显高血糖的初诊 2型糖尿病患者 ,短期CSII强化治疗具有快速稳定控制血糖和显著改善胰岛β细胞功能的作用。

Objective To evaluate the effect of short term continuous subcutaneous insulin infusion (CSII) treatment on plasma glucose and beta cell function in newly diagnosed type 2 diabetic patients with severe hyperglycemia. Methods Thirty six newly diagnosed type 2 diabetic patients with FPG>11.1 mmol/L were treated by 2 weeks CSII. An intravenous glucose tolerance test (IVGTT) was performed before and after CSII. Fasting plasma glucose (FPG), 2 hours postprandial glucose (2 hPG), glycosylated hemoglobin A 1c (GHbA 1C ), proinsulin, lipid profiles, insulin, and C peptide during IVGTT were measured. The results of FPG, 2hPG, GHbA1C, first phase insulin secretion, the mean area under the curve (AUC) of insulin and C peptide, proinsulin, proinsulin/insulin ratio, Homa β and Homa IR were compared. Results The excellent control of FPG and 2hPG in 35 out of 36 patients were achieved stably in 2.7±1.9 days and 8.5±3.5 days by CSII. After 2 weeks CSII intensive treatment, beta cell function was dramatically improved: the first phase insulin secretion of most patients was restored in different degrees, the sharp peaks of insulin release were seen in some patients. The mean AUC of insulin and C peptide and Homa β were significantly increased; plasma proinsulin, proinsulin/insulin ratio and Homa IR were decreased. Conclusion The excellent glycemic control and improvement of beta cell function can be induced by short term CSII intensive therapy in newly diagnosed type 2 diabetic patients with severe hyperglycemia.