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目的探讨初诊2型糖尿病患者短期胰岛素强化治疗后的长期疗效及长期缓解的影响因素。方法 60例初诊T2dM患者,随机分为2组,胰岛素泵强化治疗组(治疗组)和口服药对照组(对照组),各30例,治疗组经2周胰岛素泵强化治疗后,给予饮食及运动干预,若血糖不达标,则加用降糖药物;对照组仅给予饮食及运动干预,如血糖不达标,予口服降糖药物,2组患者均不用噻唑烷二酮类药物。追踪观察至少1年。结果①与强化治疗前相比,强化治疗后及1年后随访的FPG、2hPG、HOMA-IR、FINS、2hINS、TG、TC均明显降低,HOMA-β较治疗前明显升高。②对照组治疗后及1年后随访FPG、2hPG、HOMA-IR、FINS、2hINS、TG、TC有所降低,HOMA-β较治疗前明显升高(P<0.05)。③两组间比较:治疗组FPG、2hPG、HOMA-IR、FINS、2hINS明显降低,HDL、HOMA-β明显升高(P<0.05)。结论短期胰岛素泵强化治疗,可改善T2dM患者的病理生理缺陷,较肥胖的以较低胰岛素量即能达到良好控制血糖、恢复胰岛β细胞功能的初诊T2dM患者,获得长期缓解的可能性较大。
Objective To investigate the long-term efficacy and long-term relief factors of newly diagnosed type 2 diabetic patients after intensive insulin treatment. Methods Sixty patients with newly diagnosed T2dM were randomly divided into 2 groups: insulin pump intensive treatment group (treated group) and oral drug control group (control group), 30 patients in each group. After treatment with insulin pump for 2 weeks, Exercise intervention, if the blood sugar does not meet the standards, add hypoglycemic drugs; the control group only given diet and exercise intervention, such as blood glucose does not meet the standard, to oral hypoglycemic drugs, two groups of patients without thiazolidinediones. Follow up for at least 1 year. Results ① Compared with that before intensive treatment, the levels of FPG, 2hPG, HOMA-IR, FINS, 2hINS, TG and TC were significantly decreased and HOMA-β were significantly higher than those before treatment. ② The levels of FPG, 2hPG, HOMA-IR, FINS, 2hINS, TG and TC in the control group were decreased after treatment and 1 year respectively. HOMA-β was significantly higher than that before treatment (P <0.05). ③Comparison between the two groups: FPG, 2hPG, HOMA-IR, FINS and 2hINS in the treatment group were significantly decreased, HDL and HOMA-β were significantly increased (P <0.05). Conclusion Short-term intensive insulin pump therapy can improve pathophysiological defects in patients with T2dM. Compared with obese patients with newly diagnosed T2dM who can control blood sugar and restore the function of islet β cells, the patients with long-term remission may be more likely to have long-term relief.