目的:观察胰岛素泵持续皮下胰岛素输注(continuous subcataneous insulin infusion，CSII)短期强化治疗2型糖尿病(T2DM)患者的真实世界疗效并探讨疗效关联的影响因素。方法:对本院收治住院治疗的369例T2DM患者开展CSII短期强化治疗，依据治疗第5天的血糖水平，分组为血糖控制达标组和血糖控制不达标组。比较两组患者的糖代谢、生理、生化等方面指标的差异，采用回归统计方法，分析胰岛素泵疗效的影响因素。结果:经过4 d CSII短期治疗，225例(61％)患者血糖控制达标，144例(39％)血糖控制未达标。与达标组相比，未达标组年龄更大，每千克体重每日胰岛素总剂量(TDD)、空腹血糖(FBG)、空腹胰岛素、空腹C肽、胰岛素抵抗指数(HOMA-IR)水平更高，而血磷、胰岛素生长因子1(IGF1)水平则是显著低于达标组。生化指标方面，两组在血脂水平、肝功能、肾功能整体上无显著差异。单因素回归及多因素逐步回归分析结果表明，餐后2 h胰岛素、TDD、血磷是胰岛素泵疗效的关键影响因素。其中，血糖控制达标与血磷呈正相关，与餐后2 h胰岛素、TDD呈负相关。结论:使用胰岛素泵持续皮下输注胰岛素是短期强化治疗T2DM的理想方法，为了获得更满意的血糖控制达标率，临床使用时应更加关注患者的血磷、餐后2 h胰岛素指标水平及TDD。
Effects of short-term intensive insulin pump treatment on type 2 dia-betes and its influencing factors
AIM:To observe the real world effica-cy of continuous subcutaneous insulin infusion(CSII)with insulin pump in short-term intensive treatment of patients with type 2 diabetes(T2DM)and explore the influencing factors associated with efficacy.METHODS:A total of 369 hospitalized T2DM patients were treated with CSII short-term intensive therapy.Based on the blood glucose lev-els on the 5th day of treatment,they were divided into two groups,namely the qualified blood glu-cose control group and the non-qualified blood glu-cose control group.The differences of glucose me-tabolism,physiology,biochemistry and other indi-cators between the two groups were compared,and the influencing factors of insulin pump efficacy were analyzed by regression statistics.RESULTS:Af-ter 4 days of CSII short-term treatment,225 pa-tients(61％)achieved blood glucose control stan-dards,while 144 patients(39％)did not achieve blood glucose control standards.Compared with the qualified blood glucose control group,the non-qualified blood glucose control group was older and with higher levels of total daily insulin dose per kilogram of body weight(TDD),fasting blood glucose(FBG),fasting insulin,fasting C-peptide,and insulin resistance index(HOMA-IR),while low-er levels of blood phosphorus,insulin growth fac-tor 1(IGF1).In terms of biochemical indicators,there was no significant difference between the two groups as a whole,including blood lipid levels,liver function,and kidney function.The results of univariate regression and multivariate stepwise re-gression analysis showed that 2-hour postprandial insulin,TDD and blood phosphorus were the key factors influencing the efficacy of Insulin pump.Among them,qualified blood glucose control was positively correlated with blood phosphorus,and negatively correlated with 2-hour postprandial insu-lin and TDD.CONCLUSION:CSII with insulin pump is an ideal method for short-term intensive treat-ment of type 2 diabetes.In order to achieve a more satisfactory rate of qualified blood glucose control,more attention should be paid to the pa-tient's blood phosphorus,2-hour postprandial insu-lin and TDD in clinical use.
万方数据
维普
