Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore.
Sci Rep. 2017 Nov 27;7(1):16382. doi: 10.1038/s41598-017-16658-x.
It is unknown whether YOD (young onset diabetes) and LOD (late onset diabetes) require similar insulin doses for intensive insulin therapy with a metformin add-on to achieve glycemic control. We analyzed data from our two previously performed randomized, controlled open-label trials. Patients were randomized to receive either continuous subcutaneous insulin infusion (CSII) therapy or CSII combined with metformin therapy for 4 weeks. The studies concentrated on the differences in the insulin doses used for the two groups. We included 36 YOD (age < 40 yrs) and 152 LOD (age > 40 yrs) patients. YOD patients who received metformin combined with CSII therapy required significantly lower insulin doses to maintain euglycemic control compared to patients with LOD. A multivariate analysis, controlled for gender and the fasting blood concentration, was performed to determine the significance of the differences between groups, particularly with respect to the total and basal insulin doses. There was a trend toward improvement in β-cell function and insulin resistance in terms of ΔHOMA-B and ΔHOMA-IR in patients with YOD compared to those with LOD. Newly diagnosed T2D patients with YOD required significantly lower insulin doses, particularly basal insulin doses, to maintain glycemic control compared to the LOD patients.
目前尚不清楚 YOD（早发性糖尿病）和 LOD（晚发性糖尿病）在接受二甲双胍联合强化胰岛素治疗以实现血糖控制时是否需要类似的胰岛素剂量。我们分析了来自我们之前进行的两项随机、对照、开放标签试验的数据。患者被随机分配接受持续皮下胰岛素输注（CSII）治疗或 CSII 联合二甲双胍治疗 4 周。这些研究集中于两组所用胰岛素剂量的差异。我们纳入了 36 例 YOD（年龄<40 岁）和 152 例 LOD（年龄>40 岁）患者。与 LOD 患者相比，接受二甲双胍联合 CSII 治疗的 YOD 患者需要显著较低的胰岛素剂量来维持血糖正常控制。进行了多变量分析，控制了性别和空腹血浓度，以确定组间差异的显著性，特别是在总胰岛素和基础胰岛素剂量方面。与 LOD 患者相比，YOD 患者的β细胞功能和胰岛素抵抗在ΔHOMA-B 和ΔHOMA-IR 方面有改善的趋势。与 LOD 患者相比，新诊断的 T2D 患者中 YOD 需要显著较低的胰岛素剂量，尤其是基础胰岛素剂量，以维持血糖控制。
