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目的探讨短期胰岛素强化治疗初诊2型糖尿病达到临床缓解效果的影响因素。方法选取初诊2型糖尿病患者115例,按强化方案的不同分为三组:胰岛素泵强化组45例(CSII组),预混胰岛素强化组37例(Mix组),甘精胰岛素加门冬胰岛素强化组33例(MDI组)。治疗前动态血糖监测,计算24h平均血糖及24h平均血糖波动幅度;并检测糖化血红蛋白(HbA1c),空腹及口服葡萄糖耐量试验后2-h血糖、胰岛素、C肽、尿微量白蛋白。结果 115例中,临床缓解17例(缓解组),临床未缓解98例(非缓解组),缓解组HbA1c低于非缓解组[(9.08±1.97)%vs.(10.93±1.77)%](P<0.05);CSII组、Mix组、MDI组临床缓解率分别为22.2%、5.4%、5.2%,CSII组缓解率高于Mix组及MDI组(P<0.05);HbA1c<8%患者短期住院缓解率高于HbA1c≥8%患者(35.00%vs.10.53%)(P<0.05)。Logistic回归分析显示,HbA1c与临床缓解独立相关(r=0.538,P<0.05)。结论对于HbA1c轻度升高的2型糖尿病患者住院期间进行短期胰岛素强化治疗更易达到临床缓解。
Objective To investigate the influencing factors of short-term insulin intensive treatment of newly diagnosed type 2 diabetes to achieve clinical remission. Methods A total of 115 patients with newly diagnosed type 2 diabetes mellitus were enrolled in this study. They were divided into three groups according to the protocol of reinforcement: 45 in the insulin pump intensive group (CSII group), 37 in the pre-mixed insulin group (Mix group), insulin glargine plus insulin aspart Fortified group of 33 cases (MDI group). Before treatment, dynamic blood glucose monitoring was used to calculate the average blood glucose 24h and 24 hours mean blood glucose fluctuation. HbA1c, 2-hour blood glucose, insulin, C-peptide and urine microalbumin were measured after fasting and oral glucose tolerance test. Results Among the 115 cases, there were 17 cases of remission (remission group) and 98 cases of remission (non-remission group), while the HbA1c of remission group was lower than that of non remission group [(9.08 ± 1.97)% vs (10.93 ± 1.77)%] P <0.05). The remission rates in CSII, Mix and MDI groups were 22.2%, 5.4% and 5.2% respectively, and those in CSII group were higher than those in Mix group and MDI group (P <0.05) The hospitalization rate was higher than that of HbA1c≥8% (35.00% vs.10.53%) (P <0.05). Logistic regression analysis showed that HbA1c was independently associated with clinical remission (r = 0.538, P <0.05). Conclusions Short-term intensive insulin therapy during hospitalization is more likely to achieve clinical remission in patients with mild HbA1c type 2 diabetes.