·胰岛素抵抗及其相关疾病·

   　【摘要】 目的 观察不同胰岛素输注方式对成人酮症起病的糖尿病患者胰岛功能改善的影响。 方法 76例以酮症起病的糖尿病患者根据胰岛素在消酮期和消酮后期治疗方式的不同分为A组、B组和C组。观察患者治疗前、治疗后2周及治疗后15周胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能(HOMA-β)的变化。 结果 3组治疗前均存在IR和一定的胰岛功能损害。治疗后2周及15周后发现，B组HOMA-IR和HOMA-β改善最明显，C组次之，A组最差(P<0.05)。结论 T2DM酮症治疗，持续皮下输注胰岛素优于消酮期静滴胰岛素治疗及消酮后期应用皮下三餐前短/速效、睡前鱼精蛋白锌胰岛素(NPH)方法;同为持续皮下输注胰岛素治疗，消酮期和消酮后期应用基础量联合三餐前追加量的方法，劣于24 h实时血糖测定及其相应胰岛素调整的方法。

　　【关键词】 糖尿病,2型;酮症;胰岛功能;胰岛素抵抗

　　【Abstract】 Objective To evaluate the effect of different insulin infusion on beta cell function in patients with ketosis-onset diabetes. Methods 76 inpatients were divided into three groups: group A,B and C.HOMA-IR and HOMA-β were used to estimate insulin sensitivity and β-cell function respectively on the visits before treatment,after 2 and 15 weeks. Results Insulin resistance and β-cell dysfunction were found in all before treatments.Group B was improved the most,group C the more than group A after 2 and 15 weeks.(P <0.05). Conclusion To patients with ketosis-onset diabetes，continuous subcutaneous insulin infusion was better than continuous intravenous insulin infusion in the elimination of ketone period and then multiple subcutaneous insulin injection in the late cancellation ketone. About insulin pump therapy,the way of amount of additional quantity based united before meals in the elimination of ketone period and the late cancellation ketone was inferior to the way corresponding adjustment of real-time glucose insulin determination all the time .

　　【Key words】Diabetes mellitus;Ketosis;Pancreatic function;Insulin resistance