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目的观察短期胰岛素强化治疗对明显高血糖的初诊2型糖尿病患者的降糖效果、对胰岛β细胞功能的改善以及长期血糖控制的影响。方法采用自身前后对照,观察19例新诊断2型糖尿病患者接受2周胰岛素强化治疗前后空腹、餐后2小时血糖变化、静脉葡萄糖耐量试验时胰岛素第一时相分泌的变化、随访短期胰岛素强化治疗对血糖长期控制的影响。结果2周的胰岛素强化治疗后,血糖明显下降,空腹、餐后2小时血糖分别于治疗后(5.84±2.95)d、(6.11±2.87)d达到良好控制。胰岛β细胞功能在治疗后获得显著改善:静脉葡萄糖耐量试验中胰岛素曲线下面积、胰岛素峰值差值、胰岛素与血糖增量比值及HomaB指数明显升高(P<0.001);HomaA指数明显下降(P<0.001)。有14例患者仅采用饮食控制、运动疗法,平均随访6个月时糖化血红蛋白为(4.89±0.57)%,空腹血糖为(5.71±0.88)mmol/L,OGTT2h血糖为(7.03±1.58)mmol/L,空腹胰岛素为(5.83±1.57)uIU/L,OGTT2h胰岛素为(11.63±3.6)uIU/L。结论对明显高血糖的初诊2型糖尿病患者,短期多次皮下注射胰岛素强化治疗具有快速稳定的降血糖作用,能显著改善胰岛β细胞功能,减轻胰岛素抵抗,部分患者不用服任何降糖药物,仅通过饮食疗法、运动疗法就可获得良好的血糖控制。
Objective To observe the effect of short-term insulin-intensive therapy on hypoglycemic effect, improvement of pancreatic β-cell function and long-term glycemic control in newly diagnosed type 2 diabetic patients with obvious hyperglycemia. Methods The fasting and postprandial blood glucose changes of 19 patients with newly diagnosed type 2 diabetes mellitus were observed before and after 2 weeks of insulin therapy. The changes of first phase insulin secretion during intravenous glucose tolerance test were observed and followed up for short-term intensive insulin therapy Impact on long-term control of blood glucose. Results After 2 weeks of intensive insulin therapy, blood glucose was significantly decreased. Fasting and postprandial 2-hour blood glucose levels were well controlled after (5.84 ± 2.95) days and (6.11 ± 2.87) days, respectively. Islet β-cell function was significantly improved after treatment: the area under the curve of insulin, the peak value of insulin, the ratio of insulin to blood glucose and the HomaB index (P <0.001); the index of HomaA decreased significantly (P <0.001). Fourteen patients received diet control and exercise therapy only. The average HbA1c was (4.89 ± 0.57)%, fasting blood glucose (5.71 ± 0.88) mmol / L, and OGTT2h were (7.03 ± 1.58) mmol / L, fasting insulin (5.83 ± 1.57) uIU / L, OGTT2h insulin (11.63 ± 3.6) uIU / L. Conclusion In newly diagnosed type 2 diabetic patients with obvious hyperglycemia, short-term multiple subcutaneous insulin injections has a rapid and stable hypoglycemic effect, can significantly improve pancreatic β-cell function, reduce insulin resistance, some patients do not take any hypoglycemic drugs, only Through diet therapy, exercise therapy can get good blood sugar control.