初诊2型糖尿病胰岛素泵强化治疗的现状

www.yongyao.net　　2009-8-19 11:00:06　　来源：　　责任编辑：

分享到：

3　小　结

总之,对初诊2型糖尿病患者,应尽早、尽快实现胰岛素强化治疗,紧抓早期的可逆期,解除高血糖毒性作用,恢复和改善胰岛β细胞功能,减少胰岛素抵抗,改善血管内皮功能,使血糖安全平稳达标,降低或减轻糖尿病并发症。CSII治疗作为初诊2型糖尿病强化治疗的首选方式,有长期临床意义,值得临床推广使用。然而, CSII治疗的广泛应用,尚存在需进一步研究和解决的问题: ①并非所有初诊2型糖尿病均适合早期CSII治疗。治疗的适应证、疗程、成功预测指标等方面的许多因素有待进一步明确; ②这种短期良好的血糖控制对生活质量和长期健康的影响,以及对CSII治疗经济学评价的研究,国内少有报道; ③严重低血糖症发生率增高是胰岛素强化治疗的主要障碍。对2型糖尿病患者约有一半的低血糖事件是由于患者本身行为不当所引起,包括漏餐、药物剂量错误、运动或合并其他疾病等^{[ 17} ^] 。因此,患者的行为对低血糖危险起重要作用。随着新的胰岛素类似物的出现,动态血糖监测系统的联合应用,在同等疗效情况下低血糖的发生率明显降低; ④目前,胰岛素泵由于价格较昂贵及操作比较繁琐不易熟练掌握、管路时有阻塞等特点,除少部分人群拥有外,大部分都只能在医院内使用,不能广泛应于更多人群。

参考文献
[ 1 ] 　The Diabetes Control and Comp lications Trial Research Group. The effect of intensive treatment of diabetes on the development andp rogression of long2term comp lications in insulin2dependent diabetesmellitus[ J ]. N Engl J Med, 1993, 329 (14) : 9772986.
[ 2 ] 　UK Prospective Diabetes Study Group. Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of comp lications in patientswith type 2 diabetes(UKPDS 33) [ J ]. Lancet, 1998, 352 (9131) : 8372853.
[ 3 ] 　SaadMF, KnowlerWC, Pettitt DJ, et al. A two2step model for development of non2insulin2dependent diabetes [ J ]. Am J Med,1991, 90 (2) : 2292235.
[ 4 ] 　SivitzW I. Lipotoxicity and glucotoxicity in type 2 diabetes. Effects on development and p rogression[ J ]. PostgradMed, 2001, 109 (4) :55264.
[ 5 ] 　Ryan EA, Imes S,Wallace C. Short2term intensive insulin therapy in newly diagnosed type 2 diabetes [ J ]. Diabetes Care, 2004, 27(5) : 102821032.
[ 6 ] 　祝方,纪立农,韩学尧,等. 短期胰岛素强化治疗诱导初诊2型糖尿病患者血糖长期良好控制的临床试验[ J ]. 中国糖尿病杂志, 2003, 11 (1) : 529.
[ 7 ] 　李延兵,翁建平,许雯,等. 短期持续胰岛素输注治疗对初诊2型糖尿病患者胰岛β细胞功能的影响[ J ]. 中国糖尿病杂志,2003, 11 (1) : 10215.
[ 8 ] 　Ilkova H, GlaserB, Tunckale A, et al. Induction of long2term glycemic control in newly diagnosed type 2 diabetic patients by transientintensive insulin treatment [ J ]. Diabetes Care, 1997, 20 ( 9 ) :135321356.
[ 9 ] 　李延兵,廖志红,许雯,等. 胰岛素泵治疗对初诊2型糖尿病患者糖脂代谢的影响[ J ]. 中山大学学报(医学科学版) , 2004, 25(4) : 3592363.
[ 10 ] 　Raskin P,Bode BW,Marks JB, et al. Continuous subcutaneous insulin infusion and multip le daily injection therapy are equally effective in type 2 diabetes: a randomized, parallel2group, 242week study[ J ]. Diabetes Care, 2003, 26 (9) : 259822603.
[ 11 ] 　Park S, Choi SB. Induction of long2term normoglycemia without medication in Korean type 2 diabetes patients after continuous subcutaneous insulin infusion therapy[ J ]. DiabetesMetab Res Rev,2003, 19 (2) : 1242130.
[ 12 ] 　蔡穗珍,侯建明. 2 型糖尿病内皮功能紊乱与动脉粥样硬化[ J ]. 福建医科大学学报, 2006, 4 (4) : 4162418.
[ 13 ] 　朱旅云,杨少玲,田庆波,等. 胰岛素强化治疗对初诊2型糖尿病血管内皮功能的影响[ J ]. 白求恩军医学院学报, 2006, 4(4) : 1972199.
[ 14 ] 　Bode B,Weinstein R, Bell D, et al. Comparison of insulin aspart with buffered regular insulin and insulin lisp ro in continuous subcutaneous insulin infusion [ J ]. Diabetes Care, 2002, 25 ( 3 ) :4392444.
[ 15 ] 　祝开思,孙永梅,王平,等. 用诺和锐和诺和灵R持续皮下输注治疗2型糖尿病的疗效对比[ J ]. 中华糖尿病杂志, 2004, 12(6) : 36238.
[ 16 ] 　MozdzanM, Ruxer J,Loba J, et al. Safety of variousmethods of intensive insulin therapy in hosp ital condition assessed by hypoglycaemic ep isodes detected with the use of continuous glucose monitoring system[ J ]. AdvMed Sci, 2006, 51 (1) : 1332136.
[ 17 ] 　Davis S,AlonsoMD. Hypoglycemia as a barrier to glycemic control[ J ]. J Diabetes Comp lications, 2004, 18 (1) : 60268.