新诊断 2 型糖尿病患者强化胰岛素治疗后高血糖缓解：一项长期随访研究。

Remission of hyperglycemia following intensive insulin therapy in newly diagnosed type 2 diabetic patients: a long-term follow-up study.

机构信息

Department of Endocrinology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China.

出版信息

Chin Med J (Engl). 2009 Nov 5;122(21):2554-9.

PMID:19951569

Abstract

BACKGROUND

Early intensive insulin therapies in newly diagnosed type 2 diabetic patients may improve beta-cell function and yield prolonged glycemic remissions. This study was performed to evaluate the relationship between the glycemic remission and beta-cell function and assess the variables predictive of long-term near-normoglycemic remission.

METHODS

Eighty-four newly diagnosed type 2 diabetic patients were treated with 2-week continuous subcutaneous insulin infusion (CSII) and followed up longitudinally. Intravenous glucose tolerance tests (IVGTTs) were performed, and blood glucose, hemoglobin A1c (HbA1c) and insulin were measured at baseline, after CSII and at 2-year visit. The patients who maintained glycemic control for two years were defined as the remission group and those who relapsed before the 2-year visit were the non-remission group.

RESULTS

The duration to be diagnosed of the patients (from the time that patients began to have diabetic symptoms until diagnosis) in the remission group was shorter than that in the non-remission group (1.00 month vs 4.38 months, P = 0.040). The increase of the acute insulin response (AIR) was maintained after 2 years in the remission group compared with AIR measured immediately after intervention (413.05 pmol*L(-1)min(-1) vs 408.99 pmolL(-1)min(-1), P = 0.820). While AIR in the non-remission group significantly declined (74.71 pmolL(-1)min(-1) vs 335.64 pmolL(-1)*min(-1), P = 0.030). Cox model showed that a shorter duration to be diagnosed positively affected the duration of near-nomoglycemic remission with an odds ratio (OR) 1.019, P = 0.038, while fasting plasma glucose (FPG) and post-breakfast plasma glucose (PPG) after CSII were the risk factors (OR 1.397, P = 0.024 and OR 1.187, P = 0.035, respectively).

CONCLUSION

The near-normoglycemic remission is closely associated with long-term maintenance of beta-cell function and occurs more commonly in patients with shorter duration to be diagnosed and better glycemic control during CSII.

摘要

背景

新诊断的 2 型糖尿病患者早期强化胰岛素治疗可能改善β细胞功能，并获得更长时间的血糖缓解。本研究旨在评估血糖缓解与β细胞功能之间的关系，并评估预测长期接近正常血糖缓解的变量。

方法

84 例新诊断的 2 型糖尿病患者接受 2 周持续皮下胰岛素输注（CSII）治疗，并进行纵向随访。在基线、CSII 后和 2 年就诊时进行静脉葡萄糖耐量试验（IVGTT），并检测血糖、糖化血红蛋白（HbA1c）和胰岛素。将血糖控制持续 2 年的患者定义为缓解组，将在 2 年就诊前复发的患者定义为未缓解组。

结果

缓解组患者的确诊时间（从患者出现糖尿病症状到诊断的时间）短于未缓解组（1.00 个月 vs 4.38 个月，P = 0.040）。缓解组患者的急性胰岛素反应（AIR）在 2 年后仍保持升高，与干预后即刻的 AIR 相比（413.05 pmol*L(-1)min(-1) vs 408.99 pmolL(-1)min(-1)，P = 0.820）。而未缓解组患者的 AIR 显著下降（74.71 pmolL(-1)min(-1) vs 335.64 pmolL(-1)*min(-1)，P = 0.030）。Cox 模型显示，确诊时间较短与接近正常血糖缓解的持续时间呈正相关，优势比（OR）为 1.019，P = 0.038，而 CSII 后空腹血糖（FPG）和早餐后血糖（PPG）是风险因素（OR 分别为 1.397，P = 0.024 和 OR 1.187，P = 0.035）。