摘要
目的观察新诊断2型糖尿病(T2DM)经胰岛素强化治疗后患者胰岛β细胞功能改变及缓解期的长短。方法选取200例新诊断T2DM患者,均经胰岛素泵持续皮下输注胰岛素,当血糖达标后撤去胰岛素泵。记录血糖达标时间、胰岛素日用剂量,用稳态模型评估胰岛素抵抗指数(HOMA-IR)及胰岛β细胞功能指数(HOMA-β)的变化。撤去胰岛素泵后,69例患者继续给予皮下注射预混胰岛素治疗,随访3年,观察停药时血糖达标持续时间(缓解期)。结果 200例患者胰岛素泵治疗结束时血糖达到良好控制,达标时间为(5.7±2.9)d,未见严重低血糖反应。血糖达标时胰岛素剂量为(31.8±9.0)U/d;空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1 c)、HOMA-IR较治疗前显著下降,而HOMA-β、空腹C肽、空腹胰岛素(FINS)、FINS/FPG较治疗前显著升高,差异有统计学意义(P<0.01)。撤去胰岛素泵后继续使用预混胰岛素治疗者中,缓解期>1个月者占66.7%,>3个月者占60.9%,>6个月者占44.9%,>1年者占33.3%,>2年者占26.1%,>3年者占13.0%。结论 (1)短期胰岛素强化治疗可使新诊断T2DM患者的血糖迅速达标;(2)早期的胰岛素强化治疗可有效改善新诊断T2DM患者的胰岛β细胞功能,并使部分患者获得较长的缓解期。
Objective To investigate the change of β-cell and the period of remission after the insulin intensive treatment in patients with newly-diagnosed type 2 diabetes mellitus.Methods 200 patients with newly-diagnosed type 2 diabetes mellitus received short-term continuous subcutaneous insulin infusion（CSII） by insulin pump,which was removed when blood glucose reached the mark.The parameters,such as time needed to control hyperglycemia,insulin dosage and HOMA-β,HOMA-IR were observed after withdrawal CSII.69 cases were given subcutaneous insulin infusion continuously,and were followed up 3 years.The time of withdrawal of drug and the period of remission were observed and recorded.Results 200 patients′ glucose were well controlled after CSII therapy in（5.7±2.9） days.The total insulin dosage when blood glucose under control was（31.8±9.0） U daily.FPG,2 hPG,HbA1c and HOMA-IR of 69 patients were decreased significantly,while HOMA-β,fasting plasma C-peptide,FINS and FINS/FPG were increased significantly（P〈0.01）.The remission rates of patients who maintained optimal glycemic control at the first,third,sixth month,and the first,second,third year after withdrawal of insulin were 66.7%,60.9%,44.9%,33.3%,26.1%,13.0% respectively.Conclusion Short-term intensive insulin therapy enables the patients with newly-diagnosed T2DM rapidly control hyperglucose.Early-intensive insulin therapy can make the patients with newly-diagnosed T2DM achieve a long period of remission by efficiently increase β-cell function.
出处
《中国全科医学》
CAS
CSCD
北大核心
2010年第36期4055-4057,4065,共4页
Chinese General Practice
关键词
糖尿病
2型
胰岛素强化治疗
胰岛素分泌细胞
缓解
Diabetes mellitus
type 2
Intensive insulin therapy
Insulin-secreting cells
Remission
