初诊肥胖2型糖尿病患者短期胰岛素强化治疗的临床研究

Study of pancreatic beta-cell function of newly diagnosed obese patients with typc 2 diabetes

目的 研究初诊肥胖 2型糖尿病 (DM)患者短期胰岛素强化治疗后胰岛β细胞功能变化 ,探求更好的血糖控制达标方案。方法 将空腹血糖≥ 11.1mmol/ L 和 (或 )餐后 2小时血糖≥ 16 mm ol/ L 的 12 0例初诊肥胖2型 DM患者分为三组 ,其中合并酮症 19例作为 A组 ,其余随机分为 B组和 C组 (对照组 )。A、B组采用胰岛素强化治疗后同 C组一样进入研究 ,观察随访 2年时三组血糖达标后胰岛 β细胞功能变化和治疗方案。结果 随访2年时 ,三组间胰岛素分泌指数 (HOMA- IS)有显著性差异 ,C组与 A、B组和自身 1年时比较 HOMA- IS显著降低 ,但与初诊时无显著性差异 ,A、 B组满 1年时仍保持胰岛素分泌功能。A组和 B组以食疗和运动疗法以及加二甲双胍治疗为主占 78.2 % ;C组 6 8.6 %的患者需加磺脲类药物治疗 ,11.8%需要胰岛素治疗。结论 2型 DM患者经短期胰岛素强化治疗后 ,对恢复和保持胰岛β细胞功能起到一定作用 。

Objective To study the changes of pancreatic beta-cell function following-up 2 years after short-term intensive treatment with insulin in newly diagnosed obese patients with type 2 diabetes, and search for better steps to the targets of blood-glucose control.Methods We chose 120 patients, which fasting blood glucose was above 11.1 mmol/L and/or postprandial blood glucose was above 16.0 mmol/L. 19 case of patients companied with ketoacidosis were in A group, others were randomly distributed to B and C group(control group). When blood glucose of patients in A and B group got to the targets after insulin intensive therapy, they entered into our study as the same as patients in C group.Results At the end of 2 years, their HOMA-IS appeared significant difference between A and C group, B and C group,but no significant difference between A and B group. HOMA-IS of C group was significant lower than that of A and B group, and of C group itself at the end of the following-up 1 year, but no significant difference compared with themselves at the time of being diagnosed. Patients in A and B group mainly treated with dietary and exercising therapies and taking metformin, but there were 68.6% patients needing sulfonylureas and 11.8% patients needing insulin in C group. Conclusion These results indicated that short-term intensive therapy with insulin had important effects on turnning over and maitaining beta-cell function for obese patients with type 2 diabetes. After insulin intensive therapy, most obese patients arrived at good control mainly relying on fundamental therapies and metformin.