不同途径短期解除高糖毒性对老年2型糖尿病患者平衡功能的影响

摘要

目的 探讨胰岛素不同使用途径短期解除高糖毒性后,对老年2型糖尿病患者平衡功能的影响.方法将符合纳入标准的98例老年2型糖尿病(T2DM)患者作为研究对象,随机分为A组(50例)和B组(48例),A组使用短期持续性皮下胰岛素泵,B组为多次胰岛素皮下注射,通过计时起立-步行测试(TUGT)、单腿站立测试(OLST)来评估患者的动态平衡能力、静态平衡能力,5次坐立测试(FTSST)评估下肢肌力,比较两组治疗前后空腹血糖(FPG)、餐后2 h血糖(2 hPG)、TUGT、OLST(睁)、OLST(闭)、FTSST测试值的变化.结果治疗2周后,同干预前比较,两组FPG、2 hPG、TUGT、OLST(睁)值均有所改善(<0.05),且A组的TUGT、OLST(睁)值优于B组(<0.05),而OLST(闭)、FTSST值前后改善不大,差异无统计学意义(>0.05);TUGT值与年龄、病程、HbA1c、2 hPG、FTSST值呈正相关(<0.05),与OLST(睁)、OLST(闭)值呈负相关(<0.05);OLST(睁)值与年龄、FPG、TUGT、FTSST值呈负相关(<0.05),与OLST(闭)值呈正相关(<0.05).结论通过不同胰岛素使用途径特别是胰岛素泵短期解除高糖毒性后,均可改善老年2型糖尿病患者的动态平衡能力及睁眼时静态平衡能力,降低发生跌倒的风险.%Objective To investigate the protective effects of insulin injection to relieve high glucose toxicity on balance function in elderly patients with type 2 diabetes mellitus. Methods A total of 98 elderly patients with type 2 diabetes were included in this study and were randomly divided into 2 groups: A-group (50 cases) with short-term continuous subcutaneous insulin pump, and B-group (48 cases) with subcutaneous insulin injection for several times. The capability of dynamic balancing and the static balancing were evaluated by the timed up go test (TUGT) and the One-Leg Stance Test (OLST), respectively. Myodynamia of lower limbs was tested by the five times sit-stand test (FTSST). All experiments were performed before and after insulin treatments. Lab tests including fasting blood glucose (FPG), postprandial 2 h blood glucose (2 hPG) were also performed in this study. Results After 2 weeks of insulin treatment, both groups showed improvement in FPG, 2 hPG, TUGT and OLST (open) ( <0.05) while A-group experienced better recovery of TUGT and OLST (open) when compared with B-group ( <0.05). No obvious differences in FTSST and OLST (closed) were observed before and after insulin treatments ( >0.05). The TUGT value was positively correlatedwith age, stage of disease, HbA1c, 2 hPG, and FTSST ( <0.05), and negatively correlated with OLST and OLST (closed) ( <0.05). OLST value was negatively correlated with age, FPG, TUGT, and FTSST ( <0.05), and positively correlated with OLST (closed) ( <0.05). Conclusion Insulin injection to relieve glucose toxicity improves dynamic balance ability and static balance ability in elderly patients; short-term insulin pump experiences better achievement compared with discontinuous subcutaneous injection, which could be a better choice for patients with type 2 diabetes to reduce the risk of falls.