正常血糖高胰岛素钳夹法在新发糖尿病患者诊治中的应用价值

摘要

Objective To evaluate the application value of hyperinsulinemic euglycemic clamp in the diagnosis and treatment of newly-onset diabetic patients. Methods Totally 11 newly-onset diabetic inpatients (10 patients with type 2 diabetes mellitus and 1 patient with latent autoimmune diabetes of adulthood) who were diagnosed in the Department of Endocrinology of Peking Union Medical College Hospital from January 2009 to August 2009 were included in this study. Hyperinsulinemic euglycemic clamp was applied to measure the glucose disposal rate (M value). Afterwards insulin pump therapy was applied and the total insulin dosage per day to get to the target of the fasting and postprandial blood glucose was calculated. Final]y the relationships between insulin dosage per day and the M value, body mass index (BMI) , fasting blood glucose, fasting insulin level were separately analyzed. Results The insulin dosage was only negatively correlated with M value (r = - 0. 83, P = 0. 003), and was not significantly correlated with BMI (r = 0.54, P = 0.106), fasting blood glucose (r = - 0. 16, P =0. 657) , and fasting insulin (r = 0. 16, P = 0. 659). The formula of insulin dosage and M value according to the mathematic model as follows: insulin dosage per day = - 3. 327 M + 49. 849. Conclusion Hyperinsulinemic euglycemic clamp can effectively evaluate the insulin sensitivity in the newly-onset type 2 diabetic patients, and thus can be a useful tool in deciding the clinical insulin dosage.%目的 评估正常血糖高胰岛素钳夹技术在新发糖尿病患者诊治中的应用价值.方法 以2009年1月至8月在北京协和医院内分泌科就诊的新发糖尿病患者11例(2型糖尿病10例,成人迟发型自身免疫性糖尿病1例)为研究对象,采用正常血糖高胰岛素钳夹试验测定患者的葡萄糖代谢率(M);对患者进行胰岛素泵强化治疗,记录血糖达标时需要的胰岛素日剂量,分析胰岛素剂量与M及体重指数(BMI)、空腹血糖、空腹胰岛素水平的相关性.结果 胰岛素日剂量与M值呈显著负相关(r=-0.83,P=0.003),与BMI(r=0.54,P=0.106)、空腹血糖(r=-0.16,P=0.657)和空腹胰岛素水平(r=0.16,P=0.659)无关.胰岛素日剂量与M之间的换算公式为:胰岛素日剂量=-3.327 M+49.849.结论 正常血糖高胰岛素钳夹技术可有效评估新发2型糖尿病患者的胰岛素敏感性,指导临床胰岛素用量.