创新链/学科链/研发链/产业链

新药研发前沿动态 / 医药领域趋势进展

短期胰岛素泵强化治疗新发2型糖尿病患者的疗效与高血糖逆转影响因素

Efficacy of Short-Term Intensive Insulin Pump Therapy and Factors Influencing the Reversal of Hyperglycemia in Newly Diagnosed Type 2 Diabetes Mellitus

  • 摘要: 目的 探讨短期胰岛素泵强化治疗2型糖尿病(type 2 diabetes mellitus,T2DM)疗效的影响因素,并预测疗效最优的人群。方法 选取2022年12月至2024年5月在绍兴市上虞人民医院住院的156例新发T2DM患者。所有患者接受18~21d的胰岛素泵强化治疗。观察患者代谢指标变化及高血糖逆转情况,通过二元Logistic回归分析研究高血糖逆转的影响因素。结果 患者治疗后的谷丙转氨酶(alanine aminotransferase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)、总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、空腹血糖(fasting plasma glucose,FPG)、餐后2 h血糖(2-hour postprandial plasma glucose,2hPG)、稳态模型评估胰岛素抵抗指数(homeostatic model assessment of insulinresistance,HOMA-IR)低于治疗前,稳态模型评估β细胞功能指数(homeostatic model assessment of β-cell function,HOMA-β)高于治疗前(P < 0.05)。156例患者经治疗后,88例高血糖逆转,68例未高血糖逆转。逆转组的FPG、空腹胰岛素(fastinginsulin,FINS)、空腹C肽(fasting C-peptide,FCP)、2hPG、餐后2 h胰岛素(2-hour postprandial insulin,2hINS)、HOMA-IR低于未逆转组(P < 0.05)。FPG、FINS、FCP、2hINS、HOMA-IR升高是高血糖逆转失败的危险因素(P < 0.05)。结论 高水平FPG、FINS、FCP、2hINS、HOMA-IR不利于高血糖逆转,临床采用短期胰岛素泵强化治疗时应关注这些指标。

     

    Abstract: Objective To explore the factors influencing the efficacy of short-term intensive insulin pump therapy in type 2 diabetes mellitus (T2DM) and to identify the patient population that would benefit the most. Methods A total of 156 newly diagnosed T2DM patients admitted to Shangyu People's Hospital of Shaoxing City between December 2022 and May 2024 were enrolled. All patients received 18-21 days of intensive insulin pump therapy. Changes in metabolic indicators and reversal of hyperglycemia were observed. The influencing factors for reversal of hyperglycemia were studied using binary logistic regression analysis. Results After treatment, all patients showed significant decreases in levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (2hPG), and homeostatic model assessment of insulin resistance (HOMA-IR), along with an increase in homeostatic model assessment of β-cell function (HOMA-β) compared to their baseline levels (P < 0.05). After treatment, out of 156 patients, 88 achieved reversal of hyperglycemia, while 68 did not. The reversal group demonstrated lower FPG, fasting insulin (FINS), fasting C-peptide (FCP), 2hPG, 2-hour postprandial insulin (2hINS), and HOMA-IR values than the non-reversal group (P < 0.05). Elevated FPG, FINS, FCP, 2hINS, and HOMA-IR were identified as risk factors for failure to achieve reversal of hyperglycemia (P < 0.05). Conclusion High levels of FPG, FINS, FCP, 2hINS, and HOMA-IR are negatively associated with reversal of hyperglycemia. These indicators should be closely monitored when implementing short-term intensive insulin pump therapy.

     

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