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目的观察胰岛素促泌剂与强化胰岛素交替治疗对不同病程2型糖尿病胰岛功能的影响。方法将病程0～10年2型糖尿病498例,随机分为三组,治疗组病程<5年为A1组,162例,5～10年为A2组,167例,治疗24个月,对照组169例,平均(6.57±3.18)岁。观察二组患者治疗前后空腹及餐后2h血糖、糖化血红蛋白、空腹及餐后2h胰岛素的变化,计算胰岛β细胞功能指数及胰岛素抵抗指数。结果治疗24个月后,三组患者空腹、餐后2h血糖、糖化血红蛋白较治疗前明显下降(P<0.01),A1、A2组空腹、餐后2h胰岛素、胰岛β细胞功能指数较治疗前升高(P<0.05或0.01),对照组较治疗前升高,但无统计学意义,A1、A2组胰岛素抵抗指数较治疗前明显下降(P<0.05或0.01),对照组无变化;A1、A2组空腹、餐后2h血糖、糖化血红蛋白之间比较差异无统计学意义(P>0.05),A1组空腹、餐后2h胰岛素、胰岛β细胞功能指数显著高于A2组(P<0.05),而A1组胰岛素抵抗指数明显低于A2组(P<0.05);A1、A2组空腹、餐后2h血糖、糖化血红蛋白与对照组比较差异无统计学意义(P>0.05),但空腹、餐后2h胰岛素、胰岛β细胞功能指数明显高于对照组(P<0.05或0.01),而胰岛素抵抗指数明显低于对照组(P<0.05或0.01)。结论胰岛素促泌剂与强化胰岛素交替治疗不同病程2型糖尿病可有效保护胰岛β细胞功能,减轻胰岛素抵抗,越早使用交替治疗,效果越好。
Objective To observe the effects of insulin secretagogues and fortified insulin on the islet function of type 2 diabetes patients with different course of disease. Methods A total of 498 patients with type 2 diabetes mellitus with disease duration of 0 to 10 years were randomly divided into three groups. The course of disease in the treatment group was A1, 162 cases, A2 to 5 years, 167 cases, 24 months, 169 cases, mean (6.57 ± 3.18) years old. The fasting and postprandial blood glucose, glycosylated hemoglobin, fasting and postprandial 2h insulin changes in two groups before and after treatment were observed and the islet β cell function index and insulin resistance index were calculated. Results After fasting for 24 months, the fasting blood glucose, hemoglobin and HbA1c in the three groups were significantly lower than those before treatment (P <0.01). The fasting, postprandial 2h insulin and beta-cell function index of patients in A1 and A2 groups were significantly lower than those before treatment (P <0.05 or 0.01), while the control group was higher than before treatment, but there was no statistical significance. The insulin resistance index of A1 and A2 groups was significantly lower than that before treatment (P <0.05 or 0.01) The fasting, postprandial 2h insulin and beta-cell beta function index of group A1 was significantly higher than that of group A2 (P <0.05), but there was no significant difference between fasting group A2 and postprandial 2h and glycosylated hemoglobin (P> 0.05) While the insulin resistance index of group A1 was significantly lower than that of group A2 (P <0.05). There was no significant difference between fasting and postprandial 2h blood glucose and glycosylated hemoglobin in A1 and A2 groups (P> 0.05) 2h insulin, pancreatic β-cell function index was significantly higher than the control group (P <0.05 or 0.01), while the insulin resistance index was significantly lower than the control group (P <0.05 or 0.01). Conclusion The alternation of insulin secretagogues and fortified insulin in the treatment of type 2 diabetes mellitus with different course of disease can effectively protect islet β cell function and reduce insulin resistance. The earlier the effect of alternating therapy is, the better the effect is.