2019 年第 12 期 第 14 卷

胰岛素短期强化治疗后不同治疗方案对2型糖尿病患者血糖控制水平及其相关指标的影响

Influence of different treatment plans on blood glucose control in type 2 diabetic patients after short-term intensive insulin treatment

作者：周广举崔佳乐李宜臻崔素芬谢素华杨秋黄凤娇王艳

英文作者：

单位：637000四川省南充市，川北医学院附属医院内分泌科

英文单位：

关键词：2型糖尿病；强化治疗；二甲双胍；胰岛素增敏剂；血糖水平

英文关键词：

• 摘要：

• 【摘要】目的    探讨胰岛素短期强化治疗后不同治疗方案对2型糖尿病患者血糖控制水平及相关指标的影响。方法    选取2016年3月至2018年2月川北医学院附属医院收治的200例经短期胰岛素强化治疗的2型糖尿病患者为研究对象，采用随机数字表法分为3组，口服降糖药物组（66例）、预混胰岛素组（67例）以及基础胰岛素联合口服降糖药物组（67例）。所有患者随访1年，比较3组患者血糖长期缓解情况、强化治疗后和随访结束后的血糖控制水平及稳态模型胰岛素抵抗指数（HOMA-IR）、体重指数、胰岛素增量与血糖增量比值（ΔI30/ΔG30）水平。结果    随访1年后，预混胰岛素组、基础胰岛素联合口服降糖药物组长期缓解率明显高于口服降糖药物组［76.1%(51/67)、82.1%(55/67)比57.6%(38/66)］（均P＜0.05），但预混胰岛素组、基础胰岛素联合口服降糖药物组间比较差异无统计学意义（P＞0.05）。随访结束后3组患者空腹血糖、餐后2 h血糖、糖化血红蛋白水平均明显升高（P＜0.05），口服降糖药物组上述指标水平高于预混胰岛素组和基础胰岛素联合口服降糖药物组［(6.8±2.6)mmol/L比(5.1±1.4)、(5.0±1.3)mmol/L；(10.6±2.1)mmol/L比(7.2±2.3)、(7.2±2.4)mmol/L；(7.8±1.3)%比(6.9±1.3)%、(6.8±1.1)%］（均P＜0.05），而预混胰岛素组和基础胰岛素联合口服降糖药物组间差异均无统计学意义（均P＞0.05）。随访结束后3组患者HOMA-IR、体重指数均明显降低，ΔI30/ΔG30水平均明显升高，且口服降糖药物组、预混胰岛素组、基础胰岛素联合口服降糖药物组HOMA-IR、体重指数依次降低，ΔI30/ΔG30水平依次升高，组间比较差异均有统计学意义（均P＜0.05）。结论    2型糖尿病强化治疗后采用预混胰岛素或基础胰岛素联合口服降糖药物治疗效果优于口服降糖药物治疗。基础胰岛素联合口服降糖药物在控制血糖方面与预混胰岛素疗效相当，但其改善患者胰岛β细胞功能方面优于预混胰岛素。

• 【Abstract】Objective    To explore the influence of different treatment plans following short-term intensive insulin therapy on blood glucose control in patients with type 2 diabetes. Methods    Totally 200 patients with type 2 diabetes who had short-term intensive insulin therapy in Affiliated Hospital of North Sichuan Medical College from March 2016 to February 2018 were randomly assigned to have different subsequent treatment plans: oral melbine（66 cases）, premixed insulin（67 cases） and basal insulin＋melbine（67 cases）. All patients were followed up for 1 year, the long-term blood glucose control effect, homeostasis model assessment of insulin resistance index（HOMA-IR）, body mass index, the ratio of insulin to blood glucose increment（ΔI30/ΔG30） were observed. Results    The 1-year remission rate with premixed insulin and basal insulin＋melbine was significantly higher than with melbine［76.1%(51/67), 82.1%(55/67) vs 57.6%(38/66)］（both P＜0.05）, but there was no statistical difference between premixed insulin and basal insulin＋melbine(P＞0.05). At the end of 1-year follow-up, levels of fasting blood glucose, postprandial 2 h blood glucose and glycosylated hemoglobin were significantly improved in all patients［(6.8±2.6)mmol/L vs (5.1±1.4),(5.0±1.3)mmol/L； (10.6±2.1)mmol/L vs (7.2±2.3),(7.2±2.4)mmol/L； (7.8±1.3)% vs (6.9±1.3)%,(6.8±1.1)%］（all P＜0.05）; the indexes with melbine were significantly higher than with premixed insulin and basal insulin＋melbine; there was no statistical difference between premixed insulin and basal insulin＋melbine（all P＞0.05）. HOMA-IR and body mass index significantly decreased and ΔI30/ΔG30 increased after follow-up(P＜0.05); HOMA-IR and body mass index decreased and ΔI30/ΔG30 increased among melbine, premixed insulin and basal insulin＋melbine, with significant differences among them(P＜0.05). Conclusions    Premixed insulin or basal insulin＋oral hypoglycemic agent treating type 2 diabetic patients after intensive insulin treatment shows better clinical efficacy than taking oral hypoglycemic agent alone. Basal insulin＋oral hypoglycemic agent has equal effect with premixed insulin on blood glucose control, but it is superior in improving the function of islet β cells.