超短期胰岛素强化治疗对住院T2DM患者胰岛β细胞功能的影响

The effects of ultra-short-term intensive insulin treatment on β-cell function in inpatients with type 2 diabetes mellitus

摘要:

目的 探讨超短期多次胰岛素皮下注射（MDI）对2型糖尿病（T2DM）患者胰岛β细胞的临床疗效。方法 选取2018年1月—2019年12月就诊于安徽医科大学第四附属医院内分泌与代谢病科的住院T2DM患者69例。比较多次胰岛素皮下注射治疗前后胰岛β细胞功能［HOMA-β（C-P）In］变化。根据糖化血红蛋白（HbA1c）和体重指数（BMI）分为为高糖化组、低糖化组和超重组、非超重组。比较各组多次胰岛素皮下注射治疗前后HOMA-β（C-P）ln水平及其他临床指标变化，并探讨HOMA-β（C-P）In差值和其他临床指标的相关性。结果 T2DM患者多次胰岛素皮下注射治疗后FBG、FC-PIn和HOMA-IR（C-P）In较注射前下降（P <0.05），HOMA-β（C-P）In较注射前升高（P <0.05）。高糖化组患者多次胰岛素皮下注射前后FBG和HOMA-β（C-P）In差值水平较低糖化组高（P <0.05），不同HbA1c组患者多次胰岛素皮下注射前后其余指标比较，差异无统计学意义（P >0.05）。非超重组患者多次胰岛素皮下注射前后FC-Pln和HOMA-β（C-P）In差值水平FC-PIn差值较超重组高（P <0.05），HOMA-β（C-P）In差值较超重组低。不同BMI组患者多次胰岛素皮下注射前后其余指标比较，差异无统计学意义（P >0.05）。Pearson相关性分析显示，HOMA-β（C-P）ln差值水平与多次胰岛素皮下注射前FBG水平、HOMA-IR（C-P）In水平、HbA1c水平及多次胰岛素皮下注射后HOMA-IR（C-P）In水平、HOMA-β（C-P）In水平呈正相关（r =0.570、0.0331、0.237、0.307、0.560，P <0.05）；与多次胰岛素皮下注射后FBG水平、多次胰岛素皮下注射前HOMA-β（C-P）In水平呈负相关（r =-0.495、-0.400，P <0.05）。结论 多次胰岛素皮下注射治疗改善住院T2DM患者胰岛β细胞功能，且胰岛β细胞恢复和多种临床指标密切相关。

Abstract:

Objective To evaluate the effects of ultra-short-term intensive insulin treatment with the multiple daily injection (MDI) regimen on β-cell function in inpatients with type 2 diabetes mellitus (T2DM).Methods We enrolled 69 cases of T2DM inpatients admitted to the Department of Endocrinology of the Forth Affiliated Hospital of Anhui Medical University from January 2018 to December 2019. The changes of β-cell function [HOMA-β(C-P)ln] in the 69 inpatients before and after MDI treatment were compared. According to the different levels of glycosylated hemoglobin (HbA1c) and body mass index (BMI), they were divided to high/low HbA1c subgroups and overweight/non-overweight subgroups. We compared the levels of HOMA-β(C-P)ln and other indicators before and after the treatment in different subgroups, and then evaluated the correlations between the difference of HOMA-β(C-P)ln before and after the treatment and other clinical factors.Results After MDI treatment, fasting blood glucose (FBG), FC-Pln and HOMA-IR(C-P)ln were decreased (P < 0.05), while HOMA-β(C-P)ln was increased (P < 0.05). The differences of FBG and HOMA-β(C-P)ln before and after the treatment in high HbA1c subgroup were higher than those in low HbA1c subgroup (P < 0.05). Compared with overweight group, the difference of FC-Pln before and after the treatment was higher, while the difference of HOMA-β(C-P)ln before and after the treatment was lower in non-overweight subgroup (P < 0.05). Pearson correlation analysis showed that the difference of HOMA-β(C-P)ln before and after the treatment positively correlated with FBG (r = 0.570, P < 0.05), HOMA-IR(C-P)ln (r = 0.331, P < 0.05), and HbA1c (r = 0.237, P < 0.05) prior to MDI treatment, as well as HOMA-IR(C-P)ln (r = 0.307, P < 0.05) and HOMA-β(C-P)ln (r = 0.560, P < 0.05) after the treatment. However, the difference of HOMA-β(C-P)ln before and after the treatment negatively correlated with FBG (r = -0.495, P < 0.05) after MDI treatment and HOMA-β(C-P)ln (r = -0.400, P < 0.05) before the treatment.Conclusions Ultra-short-term intensive insulin treatment with MDI regimen can improve β-cell function in T2DM inpatients, and the improvement of β-cell function is associated with multiple clinical factors, though the specific mechanisms remain to be further investigated.