摘要
目的:观察不同形式的短期干预对初发2型糖尿病(T2DM)患者胰岛功能及胰岛素敏感性的影响。方法:48例初发T2DM患者随机分为胰岛素泵治疗组(CSII组)、多次胰岛素注射治疗组(MDI组)与口服降糖药治疗组(OHA组)。各组患者血糖控制达标后巩固治疗2周停药,继以饮食、运动治疗。于治疗前、停药后3天以及随访一年时分别进行静脉葡萄糖耐量试验(IVGTT),比较各组患者血糖水平、第一时相胰岛素分泌(AIR)和Homaβ。随访期间,两次空腹血糖(FPG)>7.0mmol/l和/或餐后2小时血糖(PPG)>10.0mmol/l者,记为继发失效,记录各组患者继发失效率。结果:①CSII、MDI组患者控制血糖所需时间显著低于OHA组(均P<0.05)。②各组患者治疗后血糖控制较治疗前显著改善,胰岛素原/胰岛素比值较治疗前显著降低(均P<0.05)。③与治疗前比较,CSII、MDI组患者治疗后与随访1年时Homaβ、AIR显著增加,治疗后Homa-IR显著降低;而仅在FPG>11.1mmol/l时,OHA组患者治疗后AIR显著增加(均P<0.05)。④随访期间,CSII、MDI及OHA组患者继发失效率(分别为29.4%、38.9%、38.4%)之间无显著差异(均P>0.05)。结论:与口服降糖药比较,采用短期胰岛素强化方案(CSII和MDI)治疗T2DM患者可快速稳定控制血糖,显著改善远期胰岛功能,且提高胰岛素敏感性。
Objective：To explore the effects of different short-term interventions on islet β cell function and insulin sensitivity in newly diagnosed type2 diabetes（T2DM）.Methods：48 T2DM patients were randomly assigned into therapy with continuous subcutaneous insulin infusion（CSII）or multiple daily insulin injections（MDI）or oral hypoglycaemic agents（OHA）.Treatment was stopped after normoglycaemia was maintained for 2 weeks.Patients were then followed-up on diet and exercise alone.Intravenous glucose tolerance tests（IVGTT）were done before and after therapy withdrawn and at 1-year follow-up.Fasting and postprandial plasma glucose（FPG,PPG）,hemoglobin A1c（HbA1c）,acute insulin response（AIR）and Homa β were compared among the three subgroups.During follow-up period,patients with FPG levels above 7.0mmol/l or PPG levels above 10.0mmol/l for at least twice were considered to be unsuccessful in glucose control.Results：Days of achieving euglycaemia for patients treated with CSII or MDI were significantly shorter than that with OHA.Blood glucose control was significantly improved and proinsulin/ insulin ratio was significantly decreased after therapy with either CSII,MDI or OHA.Compared with before therapy,Homa β and AIR after therapy withdrawn and at 1-year follow-up were significantly increased,while Homa-IR was significantly decreased,in patients treated with CSII or MDI.Only when FPG levels were above 11.1mmol/l,AIR after therapy was significantly increased in patients treated with OHA.No significant difference exsited in the rate of secondary failure among the three intervention groups.Conclusions：Short-term intensive insulin therapy（CSII or MDI） in newly diagnosed T2DM has favourable outcomes on quick glycaemic control,protracted improvement of β-cell function and alleviation of insulin resistance compared with treatment with OHA.
出处
《现代生物医学进展》
CAS
2010年第1期93-96,共4页
Progress in Modern Biomedicine
关键词
2型糖尿病
胰岛素敏感性
胰岛功能
治疗学
Type 2 diabetes
Insulin sensitivity
Islet β cell function
Therapy
