[早期强化治疗对不同空腹血糖水平的新诊断2型糖尿病患者胰岛β细胞功能及长期血糖控制的影响。]

[The effects of early intensive therapy on islet beta cell function and long-term glycemia control in newly diagnosed type 2 diabetic patients with different fasting plasma glucose levels.].

作者信息

Li Yan-Bing, Zeng Long-Yi, Shi Li-Xin, Zhu Da-Long, Zhou Zhi-Guang, Yan Li, Tian Hao-Ming, Luo Zuo-Jie, Yang Li-Yong, Liu Juan, Weng Jian-Ping

机构信息

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

出版信息

Zhonghua Nei Ke Za Zhi. 2010 Jan;49(1):9-13.

PMID:20356473

Abstract

OBJECTIVE

To investigate the effects of early intensive therapy on beta cell function and long-term glycemic control in newly diagnosed type 2 diabetic patients with different recruiting fasting plasma glucose (FPG) levels.

METHODS

A total of 382 newly diagnosed type 2 diabetic patients with FPG 7.0 - 16.7 mmol/L were randomly assigned to therapy with insulin in the form of continuous subcutaneous insulin infusion (CSII) or multiple daily injection (MDI) or oral hypoglycemic agents (OHA, by using gliclazide and/or metformin) for initial rapid correction of hyperglycemia. The treatments were stopped after euglycemia had been maintained for 2 weeks. The patients were followed longitudinally on diet alone for 1 year. Intravenous glucose tolerances tests (IVGTTs) were performed and blood glucose, insulin and proinsulin were measured before and after therapy as well as at 1-year follow-up. Homeostasis model assessment (HOMA) of beta cell function and insulin resistance index (HOMA-beta and HOMA-IR) were calculated. All the patients were stratified on the recruiting FPG: stratum A (7.0 mmol/L </= FPG < 11.1 mmol/L), stratum B (11.1 mmol/L </= FPG </= 16.7 mmol/L).

RESULTS

More patients in stratum A achieved target glycemic control (94.4% vs 89.8%) and in shorter time [(5.9 +/- 3.8) d vs (6.9 +/- 3.6) d, P < 0.05] as compared with those in stratum B. beta cell function represented by HOMA-beta and acute insulin response (AIR) improved significantly after intensive interventions in both stratum A and B patients. However, the remission rate at 1 year was significantly higher in stratum A patients (47.8%) than those in stratum B (35.7%, P < 0.05). The patients treated with insulin (especially with CSII) had higher remission rates and better improvement of AIR at 1 year follow-up irrespective of the recruiting FPG (CSII or MDI vs OHA: 57.1%, 51.8% vs 32.8% in stratum A, P < 0.05; 44.4%, 38.7% vs 18.6% in stratum B, P < 0.05).

CONCLUSIONS

Compared with OHA, early short time intensive insulin treatment had more favorable outcomes on maintaining AIR and prolonged glycemic remission in newly diagnosed type 2 diabetic patients irrespective of the recruiting FPG levels.

摘要

目的

探讨早期强化治疗对新诊断的2型糖尿病患者胰岛β细胞功能及长期血糖控制的影响，这些患者具有不同的入组空腹血糖（FPG）水平。

方法

总共382例新诊断的FPG为7.0 - 16.7 mmol/L的2型糖尿病患者被随机分配接受持续皮下胰岛素输注（CSII）或多次皮下注射（MDI）胰岛素治疗，或口服降糖药（OHA，使用格列齐特和/或二甲双胍）以初始快速纠正高血糖。血糖正常维持2周后停止治疗。患者仅通过饮食纵向随访1年。进行静脉葡萄糖耐量试验（IVGTT），并在治疗前、治疗后以及1年随访时测量血糖、胰岛素和胰岛素原。计算胰岛β细胞功能的稳态模型评估（HOMA）和胰岛素抵抗指数（HOMA-β和HOMA-IR）。所有患者根据入组FPG分层：A组（7.0 mmol/L ≤ FPG < 11.1 mmol/L），B组（11.1 mmol/L ≤ FPG ≤ 16.7 mmol/L）。

结果

与B组相比，A组更多患者实现了目标血糖控制（94.4% 对89.8%）且时间更短[（5.9 ± 3.8）天对（6.9 ± 3.6）天，P < 0.05]。A组和B组患者经过强化干预后，以HOMA-β和急性胰岛素反应（AIR）表示的胰岛β细胞功能均显著改善。然而，A组患者1年时的缓解率（47.8%）显著高于B组（35.7%，P < 0.05）。无论入组FPG如何，接受胰岛素治疗（尤其是CSII）的患者在1年随访时缓解率更高，AIR改善更好（A组中CSII或MDI对OHA：57.1%，51.8% 对32.8%，P < 0.05；B组中44.4%，38.7% 对18.6%，P < 0.05）。