Objective To investigate the influence of different treatment regimen on pancreatic beta-cell function and insulin resistance (IR) after initial intensive insulin therapy in newly diagnosed type 2 diabetes(T2DM).Methods A total of 90 newly diagnosed T2DM patients were enrolled in this study.All the subjects were treated with intensive insulin therapy and Metformin for 14 days,then randomized into three groups:Basal insulin group (Bal group,n=31),Premixed insulin group (Prx group,n=29) and Insulin secretagogue sulfonylureas group (Sus group,n=30).All the three groups were followed up for 3 months.After that,those patients with good β cell function and need low dose of medicine were switched to only lifestyle intervention,and patients with unsatisfactory glucose control under lifestyle intervention would be treated with Metformin,and followed up for one year.The variation of body mass index(BMI),fasting plasma glucose (FPG),glycosylated hemoglobin (HbA1c),lipids,acute insulin response (AIR),C-peptide area under curve(AUC),Homeostasis model assessment for beta cell function (HOMA-beta),Homeostasis model assessment-insulin resistance(HOMA-IR) were recorded.Results The blood glucose was significantly improved after treatment compared with befone treatment.HOMA-β[(8.44±1.19) vs (1.75±1.99),(8.67±1.26) vs (1.73±1.26),(6.34±1.41) vs (1.79±1.41),P<0.05],AUC[(20.58±4.62) vs (5.02±1.97),(21.94±5.18) vs (4.94±2.03),(15.79±4.25) vs (5.13±1.86),P<0.05] and AIR[(0.55±0.24) vs (0.16±0.12),(0.57±0.29) vs (0.18±0.10),(0.42±0.24) vs (0.18±0.11),P<0.05] were significant increased,and HOMA-IR[(0.22±0.08) vs (0.36±0.13),(0.21±0.08) vs (0.38±0.12),(0.22±0.07) vs (0.37±0.12),P<0.05]was significantly decreased in Bal,Prx and Sus group.The HOMA-β,AUC and AIR were significantly improved in Bal and Prx group than in Sus group (P<0.05).Differences of all the clinical indexes in Bal and Prx group were non-significant.The effect was extended to 1 year's following-up.Conclusion Initial intensive insulin treatment and intensive glucose control can significantly improve the beta-cell function and increase insulin sensitivity in newly diagnosed type 2 diabetic patients.Islet beta cell function can be significantly improved by treatment regimen using insulin.%目的 探讨新诊断T2DM患者胰岛素短期强化治疗后,采用3种治疗方案对胰岛β细胞功能及IR的影响.方法 90例新诊断T2DM患者口服二甲双胍联合胰岛素强化治疗14 d后,随机分为3个后续治疗组,治疗3个月:基础胰岛素组(Bal,n=31),预混胰岛素组(Prx,n=29),磺脲类促胰岛素分泌剂组(Sus,n=30),后续治疗结束后对药物用量少、胰岛功能良好者仅予生活方式干预.经生活方式干预不能达到良好血糖控制者,则予以二甲双胍为基础的口服药物治疗,随访1年;观察BMI、FPG、HbA1c、血脂、急性胰岛素分泌反应(AIR)、静脉葡萄糖耐量试验(IVGTT)、C-P曲线下面积(AUC)、胰岛β细胞指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)的变化.结果 各组治疗后血糖均得到良好控制,与强化治疗前比较,经强化及3个月的后续治疗后,Bal、Prx、Sus组HOMA-β[(1.75±1.99)vs(8.44±1.19)、(1.73±1.26)vs(8.67±1.26)、(1.79±1.41)vs(6.34±1.41),P<0.05]、AUC[(5.02±1.97)vs(20.58±4.62)、(4.94±2.03)vs(21.94±5.18)、(5.13±1.86)vs(15.79±4.25),P<0.05]、AIR[(0.16±0.12)vs(0.55±0.24)、(0.18±0.10)vs(0.57±0.29)、(0.18±0.11)vs(0.42±0.24),P<0.05]均上升,HOMA-IR下降 [(0.36±0.13)vs(0.22±0.08)、(0.38±0.12)vs(0.21±0.08)、(0.37±0.12)vs(0.22±0.07),P<0.05].与Sus组比较,Bal和Prx组的HOMA-β、AUC、AIR等指标改善明显(P<0.05),Bal和Prx间各项指标比较,差异均无统计学意义.此影响延续至随访1年时.结论 新诊断T2DM患者早期胰岛素强化治疗后强化血糖控制可改善胰岛β细胞功能,增加IS,包含胰岛素的治疗方式可改善胰岛β细胞功能.
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