Cheng Lin, Xu Mingtong, Lin Xiuhong, Tang Juying, Qi Yiqin, Wan Yan, Pan Xiaofang, Chen Xiaoyun, Ren Meng, Yan Li
Department of Endocrinology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China.
Endocr J. 2016 Aug 31;63(8):739-46. doi: 10.1507/endocrj.EJ16-0154. Epub 2016 Jun 22.
Short-term intensive insulin therapy is effective for type 2 diabetes because it offers the potential to achieve excellent glycemic control and improve β-cell function. We observed that the time to glycemic goal (TGG) was adjustable. Original data of 138 newly diagnosed type 2 diabetic patients received intensive insulin therapy by continuous subcutaneous insulin infusion for 2-3 weeks were retrospectively collected. Subjects underwent an intravenous glucose tolerance test (IVGTT) and an oral glucose tolerance test (OGTT) pre and post treatment. The glycemic goal was achieved within 6 (4-8) days. Patients were divided into two groups by TGG above (TGG-slow) and below (TGG-fast) the median value. Patients in both groups had significantly better glycemic control. Compared with TGG-fast, TGG-slow required a few more total insulin and performed more improvement of HOMA-β and IVGTT-AUCIns, but less improvement of HOMA-IR and QUICKI. Multiple linear regression analysis revealed that TGG was always an explanatory variable for the changes (HOMA-β, IVGTT-AUCIns, HOMA-IR and QUICKI). The hypoglycemia prevalence was lower in TGG-slow (1.48% vs. 3.40%, P<0.01). Multivariate logistic regression analysis indicated that individuals in TGG-slow had a lower risk of hypoglycemia (adjusted OR, 0.700; 95% CI, 0.567-0.864; P<0.05). Multiple linear regression analysis confirmed that the ratio of the incremental insulin to glucose responses over the first 30 min during OGTT (ΔIns30/ΔG30), average insulin dose before achieving targets, initial insulin dose and LDL-c were independent predictors for TGG. It is intriguing to hypothesize that patients with fast time to glycemic goal benefit more in improving insulin sensitivity, but patients with slow time benefit more in improving β-cell function and reducing the risk of hypoglycemia.
短期强化胰岛素治疗对2型糖尿病有效，因为它有可能实现良好的血糖控制并改善β细胞功能。我们观察到达到血糖目标的时间（TGG）是可调节的。回顾性收集了138例新诊断的2型糖尿病患者接受持续皮下胰岛素输注强化胰岛素治疗2 - 3周的原始数据。受试者在治疗前后进行了静脉葡萄糖耐量试验（IVGTT）和口服葡萄糖耐量试验（OGTT）。血糖目标在6（4 - 8）天内实现。患者按TGG高于（TGG - 慢）和低于（TGG - 快）中位数分为两组。两组患者的血糖控制均显著更好。与TGG - 快组相比，TGG - 慢组所需的总胰岛素量更多，HOMA - β和IVGTT - AUCIns的改善更大，但HOMA - IR和QUICKI的改善较小。多元线性回归分析显示，TGG始终是变化（HOMA - β、IVGTT - AUCIns、HOMA - IR和QUICKI）的解释变量。TGG - 慢组的低血糖发生率较低（1.48%对3.40%，P<0.01）。多因素逻辑回归分析表明，TGG - 慢组个体发生低血糖的风险较低（调整后的OR，0.700；95%CI，0.567 - 0.864；P<0.05）。多元线性回归分析证实，OGTT期间前30分钟胰岛素与葡萄糖反应增量的比值（ΔIns30/ΔG30）、达到目标前的平均胰岛素剂量、初始胰岛素剂量和低密度脂蛋白胆固醇是TGG的独立预测因素。有趣的是，可以推测血糖目标达到时间快的患者在改善胰岛素敏感性方面获益更多，但血糖目标达到时间慢的患者在改善β细胞功能和降低低血糖风险方面获益更多。
