论文部分内容阅读
目的探讨新诊断T2DM患者胰岛素短期强化治疗后,采用3种治疗方案对胰岛β细胞功能及IR的影响。方法 90例新诊断T2DM患者口服二甲双胍联合胰岛素强化治疗14 d后,随机分为3个后续治疗组,治疗3个月:基础胰岛素组(Bal,n=31),预混胰岛素组(Prx,n=29),磺脲类促胰岛素分泌剂组(Sus,n=30),后续治疗结束后对药物用量少、胰岛功能良好者仅予生活方式干预。经生活方式干预不能达到良好血糖控制者,则予以二甲双胍为基础的口服药物治疗,随访1年;观察BMI、FPG、Hb A_1c、血脂、急性胰岛素分泌反应(AIR)、静脉葡萄糖耐量试验(IVGTT)、C-P曲线下面积(AUC)、胰岛β细胞指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)的变化。结果各组治疗后血糖均得到良好控制,与强化治疗前比较,经强化及3个月的后续治疗后,Bal、Prx、Sus组HOMA-β[(1.75±1.99)vs(8.44±1.19)、(1.73±1.26)vs(8.67±1.26)、(1.79±1.41)vs(6.34±1.41),P<0.05]、AUC[(5.02±1.97)vs(20.58±4.62)、(4.94±2.03)vs(21.94±5.18)、(5.13±1.86)vs(15.79±4.25),P<0.05]、AIR[(0.16±0.12)vs(0.55±0.24)、(0.18±0.10)vs(0.57±0.29)、(0.18±0.11)vs(0.42±0.24),P<0.05]均上升,HOMA-IR下降【(0.36±0.13)vs(0.22±0.08)、(0.38±0.12)vs(0.21±0.08)、(0.37±0.12)vs(0.22±0.07),P<0.05]。与Sus组比较,Bal和Prx组的HOMA-β、AUC、AIR等指标改善明显(P<0.05),Bal和Prx间各项指标比较,差异均无统计学意义。此影响延续至随访1年时。结论新诊断T2DM患者早期胰岛素强化治疗后强化血糖控制可改善胰岛β细胞功能,增加IS,包含胰岛素的治疗方式可改善胰岛β细胞功能。
Objective To investigate the effects of three kinds of treatment regimens on the function and IR of pancreatic β-cells after the newly diagnosed T2DM patients underwent insulin short-term intensive therapy. Methods 90 patients with newly diagnosed T2DM were treated with intensive metformin plus insulin for 14 days. They were randomly divided into 3 follow-up groups for 3 months: basal insulin group (Bal, n = 31), pre-mixed insulin group = 29), and sulfonylurea insulin secretagogues group (Sus, n = 30). After the follow-up treatment, only the lifestyle intervention was given to patients who had less medication and good islet function. BMI, FPG, Hb A 1c, serum lipids, acute insulin secretion (AIR), IVGTT, and insulin resistance were measured by oral methotrexate-based oral medication after lifestyle intervention failed to achieve good glycemic control. , Area under the curve of CP (AUC), HOMA-β, HOMA-IR were measured. Results After treatment, blood glucose in each group was well controlled. HOMA-β [(1.75 ± 1.99) vs (8.44 ± 1.19), P <0.01) in the Bal, Prx and Sus groups after intensive and 3 months follow- (1.73 ± 1.26) vs (8.67 ± 1.26), (1.79 ± 1.41) vs (6.34 ± 1.41), P <0.05], AUC [5.02 ± 1.97 vs 20.58 ± 4.62 vs 4.94 ± 2.03, (P <0.05); AIR [(0.16 ± 0.12) vs (0.55 ± 0.24), (0.18 ± 0.10) vs (0.57 ± 0.29), (0.18 ± 0.10) vs (0.36 ± 0.13) vs (0.22 ± 0.08), (0.38 ± 0.12) vs (0.21 ± 0.08), (0.37 ± 0.12) vs (0.42 ± 0.24), P <0.05] ) vs (0.22 ± 0.07), P <0.05]. Compared with Sus group, HOMA-β, AUC, AIR and other indexes in Bal and Prx groups improved significantly (P <0.05). There was no significant difference between Bal and Prx indexes. This effect lasted until 1 year of follow-up. Conclusions Intensive glucose control can improve pancreatic β-cell function and increase IS in newly diagnosed T2DM patients after early intensive insulin therapy. The insulin-containing treatment can improve pancreatic β-cell function.