Ilkova H, Glaser B, Tunçkale A, Bagriaçik N, Cerasi E
Department of Internal Medicine, Istanbul University Cerrahpasa Medical Faculty, Turkey.
Diabetes Care. 1997 Sep;20(9):1353-6. doi: 10.2337/diacare.20.9.1353.
Type 2 diabetes is a slowly progressive disease, in which the gradual deterioration of glucose tolerance is associated with the progressive decrease in beta-cell function. Hyperglycemia per se has deleterious effects on both beta-cell function and insulin action, which are partially reversible by the short-term control of blood glucose levels. We hypothesized that the induction of euglycemia, using intensive insulin therapy at the time of clinical diagnosis, could lead to a significant improvement in insulin secretion and action and thus alter the clinical course of the disease.
Thirteen newly diagnosed diet-unresponsive type 2 diabetic patients were treated with continuous subcutaneous insulin infusion (CSII) for 2 weeks and followed longitudinally while being treated with diet alone.
Four patients were considered therapeutic failures since CSII failed to induce euglycemia (n = 1) or glucose control deteriorated within 6 months after CSII (n = 3). The remaining nine patients were maintained on diet alone with adequate control from 9 to > 50 months (median +/- SE, 26 +/- 4.8 months). In five patients, glycemic control deteriorated after 9-36 months, but a repeat 2-week CSII treatment reestablished control in four patients. One of these patients underwent a third CSII treatment 13 months later. At the time this article was written, six patients of the initial group were still controlled without medication 16-59 months (median +/- SE, 45.5 +/- 6.6 months) after the initiation of treatment. Body weight remained unchanged in all patients.
These findings suggest that in a significant proportion of type 2 diabetic patients who fail to respond to dietary measures, short-term intensive insulin treatment can effectively establish responsiveness, allowing long-term glycemic control without medication. Further studies are required to establish whether simpler treatment regimens could be equally effective. If the hypothesis offered here finds support, present approaches to the management of newly diagnosed type 2 diabetes may need to be revised.
2型糖尿病是一种缓慢进展的疾病，其中糖耐量的逐渐恶化与β细胞功能的逐渐下降有关。高血糖本身对β细胞功能和胰岛素作用均有有害影响，通过短期控制血糖水平，这些影响部分可逆。我们假设，在临床诊断时使用强化胰岛素治疗诱导血糖正常化，可显著改善胰岛素分泌和作用，从而改变疾病的临床进程。
13例新诊断的饮食控制无效的2型糖尿病患者接受持续皮下胰岛素输注（CSII）治疗2周，并在仅接受饮食治疗期间进行纵向随访。
4例患者被视为治疗失败，因为CSII未能诱导血糖正常化（n = 1）或在CSII后6个月内血糖控制恶化（n = 3）。其余9例患者仅通过饮食维持，血糖控制良好，时间为9至>50个月（中位数±标准误，26±4.8个月）。5例患者在9 - 36个月后血糖控制恶化，但重复进行2周的CSII治疗使4例患者重新建立了血糖控制。其中1例患者在13个月后接受了第三次CSII治疗。在撰写本文时，初始组中的6例患者在开始治疗后16 - 59个月（中位数±标准误，45.5±6.6个月）仍无需药物治疗即可维持血糖控制。所有患者体重均未改变。
这些发现表明，在很大一部分对饮食措施无反应的2型糖尿病患者中，短期强化胰岛素治疗可有效建立反应性，实现无需药物的长期血糖控制。需要进一步研究以确定更简单的治疗方案是否同样有效。如果本文提出的假设得到支持，那么目前新诊断2型糖尿病的管理方法可能需要修订。
