应用不同序贯治疗方案对新诊断2型糖尿病患者短期胰岛素泵强化治疗后胰岛α细胞、β细胞功能的影响

摘要

Objective To explore the influence of various sequential therapy regimens on function of islet α cell and β cell in newly diagnosed type 2 diabetes (T2DM) patients treated with short-term intensive insulin therapy with insulin pump. Methods A total of 60 inpatients with newly diagnosed T2DM who had two weeks of insulin pump therapy were randomly assigned to four groups treated with Metformin (MET group), Sitagliρtin (STG group), Liraglutide(LIR group)and Exenatide(EXE group), respectively. Subjects were then followed three months to observe the possible difference of various sequential therapy on the function of islet a cell and β cell. Results Compared with the status of pre-sequential therapy, three months follow-up data showed that the insulin area under the curve during intravenous glucose tolerance test in 0~10 minutes (AUCIns 0～10 min), β cell function index in hemeostasis model assessment (HOMA-β), and the glucagon area under the curve during arginine exciting test in 0 ~8 minutes (AUCGln 0～8min) had no significant changes (P>0. 05) in MET group. In contrast, the AUCIns 0～10 min and HOMA-β were all significantly increased and AUCGln 0～8 min were significantly decreased in STG group, LIR group and EXE group(all P<0. 05). The changes of AUCIns 0～10 min, HOMA-β and AUCGln 0～8 min in LIR group and EXE group were significantly higher than those in MET group and STG group. Conclusion Incretins may be better than Metformin to improve the defects of pathophysiology in newly diagnosed T2DM after short-term intensive insulin pump therapy, in which liraglutide and exenatide were better than sitagliptin.%目的探讨新诊断T2DM患者短期胰岛素泵强化治疗(CSII)后应用不同的序贯治疗方案 对胰岛α细胞、β细胞功能的影响.方法给予60例新诊断T2DM患者2周胰岛素泵强化治疗后随机 分为4组,分别给予二甲双胍(MET组)、西格列汀(STG组)、利拉鲁肽(LIR组)和艾塞那肽(EXE组)为 期12周序贯治疗,评价应用不同的序贯治疗方案对胰岛α细胞、β细胞功能相关指标的影响.结果 与序贯治疗前相比,MET组中静脉葡萄糖耐量试验中0~10 min胰岛素曲线下面积(AUCIns 0～10 min)、稳 态模型胰岛β细胞功能指数(HOMA-β)、精氨酸兴奋试验中0~8 min胰升血糖素曲线下面积 (AUCGln 0～8 min)均无明显变化(P>0. 05),而在STG组、LIR组、EXE组中,AUCGln 0～8min降低, AUCIns 0～10 min、HOMA-β 均升高(P < 0. 05).LIR组和 EXE组 △AUCIns 0～10 min、ΔHOMA-β、 ΔAUCGln 0～8 min均较MET组和STG组升高(P<0. 05或P<0. 01). 结论新诊断T2DM患者短期 CSⅡ后序贯应用肠促胰素药物较二甲双胍能更好改善T2DM的病理生理缺陷,其中艾塞那肽和利拉鲁 肽的作用优于西格列汀.