海南医科大学学报

目的:探讨初诊2型糖尿病患者胰岛素强化治疗对血糖控制的影响。方法:对于血糖较高的初发2型糖尿病患者,给予胰岛素序贯强化治疗(首先给予CSII治疗2周,对于胰岛功能恢复较差的患者再给予预混胰岛素),随访1年,分析比较其治疗前后空腹及餐后2小时血糖、糖化血红蛋白、静脉葡萄糖耐量(IVGTT)试验时胰岛素第一时相分泌(AIR)和由Homa模型计算的β细胞功能指数(HOMAβ)、胰岛素抵抗指数(HOMA IR)等。结果:随访终点时,37例(51.4%)患者仅通过饮食及运动使血糖稳定控制1年,为缓解组;35例(48.6%)患者停用CSII后血糖逐步升高,需降糖药物控制血糖,为观察组。经过2周CSII治疗后两组血糖均明显下降,缓解组患者CSII治疗后空腹及餐后2小时血糖均明显低于观察组,伴随胰岛素第一时相分泌(AIR)高于观察组,差异有统计学意义(P<0.05)。结论:对于血糖较高的初发2型糖尿病患者,胰岛素序贯强化治疗具有快速稳定控制血糖和显著改善胰岛β细胞功能及胰岛素抵抗的作用。

Objective: To explore the influence of the intensive insulin therapy on plasma glucose control in newly diagnosed type 2 diabetic patients.Methods:Newly diagnosed type 2 diabetic patients with severe hyperglycemia were treated by personal intensive insulin treatment(first,patients were treated with continuous subcutaneous insulin infusion for 2 weeks and then patients with poor outcomes were treated with premixed insulin).Follow up was conducted for 1 year to analyze and compare fasting plasma glucose(FPG),2 hours postprandial glucose(2hPG),glycosylated hemoglobin A1c(GHbA1C),first-phase insulin secretion.HOMAβ and HOMA IR were calculated and compared too.Results:Thirty seven patients maintained remission stage for more one year were defined as remission group,thirty five patients who needed continuous intensive therapy were defined as observation group.Both groups showed significant decrease in glucose level,but the 2 hours postprandial glucose level of the remission group was significantly lower,but A-IR was higher than that of the observation group(P<0.05).Conclusion: intensive insulin therapy shows good effects of controlling glucose level,improving function of βcells,and alleviate the insulin resistance.