达格列净联合胰岛素泵短期强化治疗初诊 2 型糖尿病高血糖的疗效观察

Effects of dapagliflozin combined with insulin pump in hyperglycaemia patients with newly diagnosed type 2 diabetes

摘要:

目的 评价达格列净联合胰岛素泵强化治疗初诊2 型糖尿病（T2DM）高血糖的疗效。方法 选 取2017 年6 月—2018 年9 月于郑州大学附属郑州中心医院高新院区内分泌科住院的T2DM 高血糖患者38 例。 19 例患者单用胰岛素泵治疗作为对照组，19 例患者予达格列净联合胰岛素泵治疗作为实验组。入院后行口服 葡萄糖耐量试验，完成检查后给予胰岛素泵治疗，血糖达标维持1 周后复查相关指标，包括Cederholm 的胰 岛素敏感性指数、稳态模型胰岛素对抗指数（HOMA-IR）、胰岛素分泌指数、早时相胰岛素分泌指数、胰 岛素二相分泌的OGTT 胰岛素曲线下面积及β 细胞功能评定指数。结果 对照组治疗后血糖达标时间、初 次达标时胰岛素用量及停泵时胰岛素用量均高于实验组（P <0.05）；两组患者治疗后HOMA-IR 较治疗前下 降（P <0.05），同时Cederholm 胰岛素敏感性指数、胰岛素分泌指数、早时相胰岛素分泌指数、胰岛素二相 分泌的OGTT 胰岛素曲线下面积、β 细胞功能评定指数、胰岛素分泌指数/HOMA-IR、早时相胰岛素分 泌指数/HOMA-IR、胰岛素二相分泌的OGTT 胰岛素曲线下面积/HOMA-IR 及β 细胞功能评定指数/ HOMA-IR 较治疗前升高（P <0.05）。结论 达格列净联合胰岛素泵治疗初诊T2DM 高血糖患者，在达标时间、 胰岛素总剂量及强化治疗后胰岛素用量方面均可获益，并可改善患者的胰岛功能，增强胰岛素敏感性。

Abstract:

Objective To investigate the effects of dapagliflozin combined with medtronic insulin pump in newly diagnosed type 2 diabetic patients. Methods A total of 38 cases of newly diagnosed diabetic patients between June 2017 and September 2018 were recruited and randomized to receive either of two therapies: Medtronic 712 insulin pump alone group (group A, 19 cases) or Medtronic 712 insulin pump combination with dapagliflozin (group B, 19 cases). Oral glucose tolerance tests (OGTT) was carried out on these patients. After that, all patients received treatment of Medtronic 712 insulin pump or Medtronic 712 insulin pump combination with dapagliflozin. The treatment continued for 1 week after blood glucose had reached the standard. All the indicators were reviewed. β-cell function was measured by HOMA-β, AUC Ins and MBCI, and insulin resistance was evaluated by HOMA-IR and ISIced. Results After treatment, the time of reaching target of glucose and the total insulin dosage in reaching target of glucose and at the end of insulin pump treatment in the group B were more higher than those in the A group (P < 0.05); after treatment, the level of HOMA-IR was lower (P < 0.05), meanwhile ISIced, HOMA-β, ΔI30/ΔG30, AUC Ins, MBCI, HOMA-β/HOMA-IR, ΔI30/ΔG30/HOMA-IR, AUC Ins/ HOMA-IR and MBCI/HOMA-IR were higher (P < 0.05). Conclusions The effects of dapagliflozin combined with Medtronic insulin pump in newly diagnosed type 2 diabetic patients will benefit from the time of reaching target of glucose, the total insulin dosage in reaching target of Glucose, the total insulin dosage at the end of insulin pump treatment and improve their β cell function and insulin sensitivity.