两种不同治疗方案对初诊2型糖尿病患者短期胰岛素强化治疗后长期缓解的影响

摘要

Objective To explore the influence of two kinds of various treatment plans on long-term remission by short-term intensive insulin therapy in newly diagnosed type 2 diabetes mellitus(T2DM) patients. Methods A total of 84 inpatients with newly diagnosed T2DM who had a two-week course of insulin therapy were randomly assigned to two groups, the first group of administrated metformin agent ( MET group) and the second group of administrated insulin-sensitizer agent(TZD group). Subjects were then followed at least one year, and possible differences of two treatment plans on long-term remission were observed. Results ①At one year in follow-up, the remission rate was 66. 7%(28/42) in MET group.and the remission rate was 71. 4% (30/42)in TZD group. The remission rate was no statistic siginificance between MET group and TZD group(x2 =0. 22, P >0. 05).②At the end of one year's follow-up, the value of Homeostasis Model Assessment of Insulin Resistance(HOMA-IR) was significantly lower.1. 14±0. 22 vs 1. 46±0. 25,and the value of the ratio of insulin from 0 to 30 min to glucose from 0 to 30 mimes(△I30/△G30), the increment of HOMA-1R, △I30/△G30( value of the end of one year follow-up minus that of stopping intensive therapy) were all significantly higher in TZD remission group,as compared with MET remission group,2. 61 ±0. 29 vs 2. 08± 0. 33( P <0. 01). Conclusion As sooner administrating metformin agent or insulin-sensitizer agent after the short-term intensive insulin treatment in newly diagnosed T2DM patients can induce a relatively long term remission of diabetes mellitus. Insulin-sensitizer agent might better improve the shortage of pathophisiology of T2DM compared with metformin agent.%探讨两种不同治疗方案对初诊2型糖尿病(T2DM)患者短期胰岛素强化治疗后长期缓解的影响.方法 新诊断的T2DM患者84例,经过2用的胰岛素强化治疗后,随机分为2组:二甲双胍组(MET组)和胰岛素增敏剂组(TZD组),追踪观察至少1年时间,了解两种治疗方案在诱导糖尿病病情缓解作用方面的可能差异.结果 ①随访1年时,MET组缓解率66.7％(28/42),TZD组缓解率71.4％(30/42),两组间缓解率差异无统计学意义(x2=0.22,P＞0.05).②在1年随访结束时,与MET缓解组相比,TZD缓解组穗态模型胰岛素抵抗指数(HOMA-IR)更低,1.14±0.22 vs l.46±0.25(P＜0.05),100 g馒头餐后30分钟内INS增值与血糖增值的比值(△I10/△G30),2.61±0.29 vs2.08±0.33以及HOMA-IR、△I30/△G30的1年随访结束各自变化值均更高(P＜0.01).结论 初诊2型糖尿病患者短期胰岛素强化治疗后应用二甲双胍以及胰岛素增敏剂治疗均可获得较高的长期缓解机会.胰岛素增敏剂可能较二甲双胍能更好改善T2DM的病理生理缺陷.