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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 observe the effects of different forms of short-term intervention on islet function and insulin sensitivity in patients with newly diagnosed type 2 diabetes mellitus (T2DM). Methods: 48 patients with newly diagnosed T2DM were randomly divided into insulin pump treatment group (CSII group), multiple insulin injection treatment group (MDI group) and oral hypoglycemic drug treatment group (OHA group). Each group of patients with blood glucose control after consolidation treatment for 2 weeks withdrawal, followed by diet, exercise therapy. Intravenous glucose tolerance test (IVGTT) was performed before treatment, 3 days after drug withdrawal and one year after follow-up. Blood glucose level, first phase insulin secretion (AIR) and Homaβ were compared between the two groups. During follow-up, two fasting blood glucose (FPG)> 7.0 mmol / l and / or 2-hour postprandial blood glucose (PPG)> 10.0 mmol / l were recorded as secondary failure and the secondary failure rate was recorded. Results: ① The time required for blood sugar control in CSII and MDI patients was significantly lower than that in OHA patients (all P <0.05). ② The glycemic control in all groups was significantly improved after treatment, and the ratio of proinsulin / insulin was significantly lower than that before treatment (all P <0.05). ③Compared with pre-treatment, the Homaβ and AIR in CSII and MDI group increased significantly after 1-year follow-up, and Homa-IR decreased significantly after treatment. Only when FPG> 11.1mmol / l, OHA group had significant AIR after treatment Increase (all P <0.05). During the follow-up period, there was no significant difference in secondary failure rate between CSII, MDI and OHA patients (29.4%, 38.9%, 38.4% respectively) (all P> 0.05). CONCLUSION: Compared with oral hypoglycemic agents, treatment of T2DM with short-term insulin boost (CSII and MDI) can rapidly and steadily control blood glucose, significantly improve long-term islet function and improve insulin sensitivity.