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目的探讨初诊2型糖尿病胰岛素泵短期强化治疗对β细胞功能及其病程的影响。方法对空腹血糖>11.1mmol/L的36例初诊2型糖尿病患者进行2周的持续胰岛素皮下输注(CSⅡ)强化治疗,对比分析治疗前后血糖、胰岛素、C肽、糖化血红蛋白(HbA1c)、胰岛β细胞功能(HOMA-β)和胰岛素抵抗指数(HOMA-IR)等变化。随访患者血糖控制情况2年,分析临床缓解有关因素。结果2周的CSⅡ治疗后空腹及餐后2h血糖分别由(13.6±1.5)mmol/L、(20.1±4.0)mmol/L降至(5.6±0.4)mmol/L、(8.2±1.4) mmol/L,达到良好控制(P<0.01),且未见明显低血糖。治疗后C肽水平(1.3±0.4)μg/L,较治疗前(0.8±0.2)μg/L明显升高(P<0.05),HOMA-β(95±34),较治疗前(27±9)明显提高(P<0.02),HOMA-IR(1.26±0.29),较治疗前(2.31±0.52)明显下降(P<0.05)。随访2年,单纯饮食运动组较需加用口服药组BMI和治疗后空腹血糖低(P<0.05),血糖达标所需时间及胰岛素平均用量少(P<0.05,P<0.01)。结论胰岛素泵CSⅡ强化治疗能在短期内达到理想血糖控制,有利于胰岛β细胞功能的恢复,部分患者能够获得较长时间的临床缓解。
Objective To investigate the effect of insulin pump short-term intensive treatment on the function and duration of β-cell in newly diagnosed type 2 diabetic patients. Methods Thirty-six patients with newly diagnosed type 2 diabetes with fasting blood glucose> 11.1mmol / L were treated with continuous insulin subcutaneous infusion (CSII) for two weeks. The levels of blood glucose, insulin, C peptide, HbA1c, β-cell function (HOMA-β) and insulin resistance index (HOMA-IR) and other changes. Follow-up of patients with glycemic control for 2 years, analysis of the factors related to clinical remission. Results After 2 weeks of treatment, the fasting and 2h postprandial plasma glucose were decreased from (13.6 ± 1.5) mmol / L and (20.1 ± 4.0) mmol / L to (5.6 ± 0.4) mmol / L and L, achieving good control (P <0.01), with no apparent hypoglycemia. The level of C-peptide after treatment was 1.3 ± 0.4 μg / L, which was significantly higher than that before treatment (0.8 ± 0.2) μg / L and 95 ± 34 (HOMA-β) ) (P <0.02), HOMA-IR (1.26 ± 0.29), which was significantly lower than that before treatment (2.31 ± 0.52) (P <0.05). After 2 years of follow-up, the dietary exercise group had lower BMI and lower fasting blood glucose (P <0.05) after oral administration, and the time required for achieving blood glucose level and less insulin (P <0.05, P <0.01). Conclusion Insulin pump intensive treatment of CS Ⅱ can achieve the ideal blood sugar control in a short period of time, which is beneficial to the recovery of pancreatic β-cell function, and some patients can obtain long-term clinical remission.