胰岛素治疗对口服降糖药继发失效的非胰岛素依赖型糖尿病患者的影响。

Effects of insulin therapy on non-insulin-dependent diabetics with secondary oral hypoglycemic agent failure.

作者信息

Peng Y S, Juang J H

机构信息

Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C.

出版信息

Changgeng Yi Xue Za Zhi. 1998 Sep;21(3):271-6.

PMID:9849007

Abstract

BACKGROUND

To search for the mechanisms of secondary oral hypoglycemic agent (OHA) failure in non-insulin-dependent diabetic (NIDD) and to identify the effects of insulin therapy on these patients, we observed their pancreatic beta-cell function and metabolic parameters.

MATERIALS AND METHODS

The clinical characteristics and C-peptide responses to glucagon were analyzed in 37 NIDD with secondary OHA failure. All patients received insulin therapy and we measured their fasting plasma glucose (FPG), body mass index (BMI) and glycohemoglobin (HbA1C) levels at 3 months, their serum triglyceride and cholesterol levels at 6-12 months and performed glucagon tests at 0.5-29 months.

RESULTS

Poor beta-cell function was observed in 11 (29.7%) patients (Group A) and fair beta-cell function in 26 (70.3%) patients (Group B). The mean age at diagnosis, the number of years since diagnosis of diabetes, FPG levels and HbA1C levels were similar in both groups. However, the patients in Group A had a lower average BMI (18.9 +/- 0.7 vs 22.1 +/- 0.6 kg/m2, p = 0.006) than those of Group B. After insulin therapy, the FPG levels (215 +/- 14 vs 282 +/- 12 mg/dL, p < 0.001) and HbA1C levels 9.2 +/- 0.5 vs 11.6 +/- 0.5%, p < 0.001) of both groups decreased but the BMI (23.1 +/- 0.7 vs 21.6 +/- 0.7 kg/m2, p < 0.001) increased significantly. However, the blood lipid levels and beta-cell function did not change. The beta-cell function was still poor in 5 out of 6 patients in Group A, but it was unchanged in all patients in Group B.

CONCLUSION

About 1/3 of NIDD with secondary OHA failure are permanently insulin deficient and need long-term insulin treatment.

摘要

背景

为探寻非胰岛素依赖型糖尿病（NIDD）患者口服降糖药（OHA）继发性失效的机制，并明确胰岛素治疗对这些患者的影响，我们观察了他们的胰岛β细胞功能和代谢参数。

材料与方法

分析了37例OHA继发性失效的NIDD患者的临床特征及对胰高血糖素的C肽反应。所有患者均接受胰岛素治疗，我们在3个月时测量其空腹血糖（FPG）、体重指数（BMI）和糖化血红蛋白（HbA1C）水平，在6 - 12个月时测量其血清甘油三酯和胆固醇水平，并在0.5 - 29个月时进行胰高血糖素试验。

结果

11例（29.7%）患者（A组）胰岛β细胞功能较差，26例（70.3%）患者（B组）胰岛β细胞功能尚可。两组患者的诊断时平均年龄、糖尿病确诊年限、FPG水平和HbA1C水平相似。然而，A组患者的平均BMI（18.9±0.7 vs 22.1±0.6 kg/m²，p = 0.006）低于B组。胰岛素治疗后，两组患者的FPG水平（215±14 vs 282±12 mg/dL，p < 0.001）和HbA1C水平（9.2±0.5 vs 11.6±0.5%，p < 0.001）均下降，但BMI（23.1±0.7 vs 21.6±0.7 kg/m²，p < 0.001）显著升高。然而，血脂水平和β细胞功能未发生变化。A组6例患者中有5例的β细胞功能仍较差，但B组所有患者的β细胞功能未改变。