Miyazaki Takashi, Shirakawa Jun, Nagakura Jo, Shibuya Makoto, Kyohara Mayu, Okuyama Tomoko, Togashi Yu, Nakamura Akinobu, Kondo Yoshinobu, Satoh Shinobu, Nakajima Shigeru, Taguri Masataka, Terauchi Yasuo
Department of Endocrinology and Metabolism, Yokohama City University Graduate School of Medicine, Japan.
Department of Endocrinology and Metabolism, Chigasaki Municipal Hospital, Japan.
Intern Med. 2019 Dec 1;58(23):3361-3367. doi: 10.2169/internalmedicine.3060-19. Epub 2019 Jul 22.
Objective Delays in insulin initiation can lead to the development of complications in the management of type 2 diabetes. Methods In this study, the effects of the timing of insulin initiation on glycemic control in patients with type 2 diabetes were evaluated retrospectively. Changes in the HbA1c levels of 237 patients were analyzed after insulin initiation. Results The patients were divided into 4 groups according to the duration of diabetes at the time of insulin initiation: ≤3 years, 4 to 6 years, 7 to 9 years, or ≥10 years. Patients with a diabetes duration of ≤3 years were more frequently hospitalized at the time of insulin initiation, had a higher HbA1c level before insulin initiation and a lower HbA1c level at 1 year after insulin initiation and exhibited significant decreases in HbA1c at 1, 3, or 5 years after insulin initiation than those in the other 3 groups with longer durations of diabetes. In the group receiving 4 insulin injections per day, the reduction in HbA1c after 5 years of treatment was larger in patients with a diabetes duration at the time of insulin initiation of ≤3 years than in those with a duration of 7 to 9 years or ≥10 years. Conclusion Our results suggested that an earlier initiation of insulin therapy was crucial for sustaining glycemic control in Japanese patients with type 2 diabetes, particularly in those with a history of obesity or receiving multiple insulin injections daily.
目的 胰岛素起始治疗延迟可导致2型糖尿病管理中并发症的发生。方法 在本研究中，回顾性评估了胰岛素起始治疗时机对2型糖尿病患者血糖控制的影响。分析了237例患者胰岛素起始治疗后糖化血红蛋白（HbA1c）水平的变化。结果 根据胰岛素起始治疗时的糖尿病病程，将患者分为4组：≤3年、4至6年、7至9年或≥10年。糖尿病病程≤3年的患者在胰岛素起始治疗时住院频率更高，胰岛素起始治疗前HbA1c水平更高，胰岛素起始治疗1年后HbA1c水平更低，且与糖尿病病程更长的其他3组相比，胰岛素起始治疗后1、3或5年时HbA1c显著降低。在每天注射4次胰岛素的组中，胰岛素起始治疗时糖尿病病程≤3年的患者治疗5年后HbA1c的降低幅度大于病程为7至9年或≥10年的患者。结论 我们的结果表明，早期开始胰岛素治疗对于维持日本2型糖尿病患者的血糖控制至关重要，尤其是对于有肥胖史或每天接受多次胰岛素注射的患者。
