【摘要】 目的　 比较初诊肥胖 2型糖尿病 (DM )患者血糖控制方法 ,观察短期胰岛素强化治疗后对后续治疗方法的影响和胰岛 β细胞功能的变化。方法　 对空腹血糖≥ 11.1mmol/L和 (或 )餐后2h血糖≥ 16mmol/L的初诊肥胖 2型DM患者 12 0例 ,将其中合并酮症者 19例作为A组 ,其余患者随机分为B组和C组 (对照组 )。A组和B组采用胰岛素强化治疗 ,C组应用二甲双胍或 /和磺脲类药物联合治疗 ,待其血糖控制达标之后 ,3组患者开始进入研究 (后期治疗 ) ,并随访 30个月 ,比较其治疗方案和观察胰岛 β细胞功能的变化。结果　 非药物治疗和需加二甲双胍治疗者 :随访 12个月时 ,A、B、C组分别为 94 .7%、90 %、4 3.2 % ;随访 2 4个月时 ,A、B、C组分别为 73.7%、82 .0 %、19.6 % ;随访 30个月时 ,A、B、C组分别为 6 3.1%、74 .0 %、17.6 % ;3组各随访时间患者的构成比较均有统计学意义 (P <0 .0 5或P <0 .0 1)。稳态模型胰岛素分泌指数 (Homa IS) :随时间的延长 ,C组呈逐渐降低趋势 (P <0 .0 5 ) ,A、B组变化无统计学意义 (P >0 .0 5 )。 结论　2型DM患者经短期胰岛素强化治疗后 ,对恢复和保持胰岛 β细胞功能起到一定作用 ,30个月内大多数患者治疗可以非药物治疗和二甲双胍为主。更多还原

【Abstract】 Objective To compare different methods of co nt rollig blood glucose of patients with Type 2 diabetes mellitus and to observe th e effects of initial short-term intensive treatments on the functions of islet β cells.Methods 120 cases of Type 2 diabetes mellitus with their fasting blood glucose being above 11.1mmol/L an/or with their blood glucose bei ng abore 16mmol/L two hours after meals were classified into Group A(chose suffe ring ketosis),Group B and Group C. Group A and Group were treated with.Intensive insulin treatment.Group C was treated with dimethyldiguanide and /or sulfaurea drugs.The follow-up surveys lasted 30 months.The effects of different therapies and the changes in the functions of β cells were compared.Results The follow-up surveys revealed that the curative effects of non-drug treatrne nts and the application of dimethyldiguanide in Group A.Group B and Group C at t he end of the 12th month,24 th month and 30th month were 94.7%,90% and 43.2%;73. 7%,82.0% and 19.6%;and 63.1%,74.0% and 17.6% respectively.The Homa-ZS showed tha t the curative effects in Group C declined significantly (P<0.05).There exis ted no difference in Group A and Group B(P>0.05).Conclusion T he short-term intensive treatment with dimethyldiguanide can help to restore and keep the functions of islet β cells.Non-drug treament and the application of d imethyldiguanide can play a key role in treating most patients with Type 2 diabe tes mellitus.更多还原