Kayashima T, Yamaguchi K, Konno Y, Nanimatsu H, Aragaki S, Shichiri M
First Department of Internal Medicine, Oita Prefectural Hospital, Japan.
Diabetes Res Clin Pract. 1995 May;28(2):119-25. doi: 10.1016/0168-8227(95)01066-m.
In order to reconsider the extent of indication of insulin therapy in non-insulin dependent diabetes mellitus (NIDDM), we performed the following trial in a prospective fashion. At the beginning phase of treatment for diabetes, we introduced intensive insulin therapy in 22 non-obese (Body mass index approximately 24 kg/m2) NIDDM patients without proliferative retinopathy, who were selected in a standardized fashion, avoiding any arbitrary choice. None had received oral hypoglycemic agents (OHA) or insulin yet. By administering insulin 3 or 4 times a day, strict glycemic control was attained and maintained, and then the insulin dose was gradually lowered while keeping good glycemic control. In patients whose glycemic control was maintained at an excellent level for more than 7 days under an insulin dosage lower than 8 u/day, insulin therapy was discontinued. As a result, 15 patients (68%) attained good glycemic control both without insulin and OHA almost within a month and 6 patients (27%) shifted to OHA. It is recommended to introduce intensive insulin therapy in non-obese NIDDM patients without proliferative retinopathy and to aim at attaining good glycemic control both without insulin and OHA.
为重新考虑非胰岛素依赖型糖尿病（NIDDM）胰岛素治疗的适应证范围，我们以前瞻性方式进行了以下试验。在糖尿病治疗的起始阶段，我们对22例无增殖性视网膜病变的非肥胖（体重指数约24kg/m²）NIDDM患者采用强化胰岛素治疗，这些患者是通过标准化方式挑选出来的，避免了任何随意选择。所有患者此前均未接受过口服降糖药（OHA）或胰岛素治疗。通过每天注射3次或4次胰岛素，实现并维持了严格的血糖控制，然后在保持良好血糖控制的同时逐渐减少胰岛素剂量。对于那些在胰岛素剂量低于8单位/天的情况下血糖控制良好超过7天的患者，停止胰岛素治疗。结果，15例患者（68%）在几乎一个月内无需胰岛素和OHA即可实现良好的血糖控制，6例患者（27%）转而使用OHA。建议对无增殖性视网膜病变的非肥胖NIDDM患者采用强化胰岛素治疗，并旨在实现无需胰岛素和OHA即可达到良好的血糖控制。
