新たに診断された2型糖尿病患者のベータ細胞機能と血糖制御に対するインセンティブインスリン療法の効果:多センターランダム化並列群試験
Jianping Weng1, Yanbing Li, Wen Xu
1Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. wjianp@mail.sysu.edu.cn
Lancet (London, England)
|May 27, 2008
まとめ
継続的な皮膚下インスリン注入 (CSII) または毎日複数の注射 (MDI) を含む早期の集中インスリン治療は,ベータ細胞機能を大幅に改善し,経口薬と比較してより高い糖尿病寛解率を達成します.
科学分野:
- エンドクリノロジー エンドクリノロジー
- メタボリック疾患
- 糖尿病に関する研究
背景:
- 新たに診断された2型糖尿病 (T2D) の管理は,長期的な結果にとって極めて重要です.
- 早期の集中的な介入はベータ細胞の機能を向上させ,血糖性の寛解を長引かせる可能性があります.
- インスリン療法と口服薬の比較は,T2Dの治療戦略を最適化するために不可欠です.
研究 の 目的:
- 新たにT2Dと診断された患者で,経口低血糖薬 (OHA) と対照的に,一時的な集中インスリン療法 (CSIIまたはMDI) の有効性を比較する.
- これらの治療がベータ細胞機能と糖血性寛解率に与える影響を評価する.
- 1年間のフォローアップで治療効果の持続性を評価する.
主な方法:
- 382人のT2D患者で,7.0-16.7 mmol/Lの間の断食プラズマグルコースを有する多センターランダム化試験.
- 患者はインスリン (CSII/MDI) またはOHAによる初期集中治療を受け,急速な高血糖症の矯正を受けた.
- 治療はノルモグリケミアの2週間後に中止され,その後ライフスタイルの介入とベータ細胞機能評価による1年間のフォローアップが行われました.
主要な成果:
- インスリングループ (CSII/MDI) は,OHAグループと比較して,目標の血糖コントロールをより速く,より高い割合の患者で達成しました.
- 1年間の寛解率は,OHAグループ (26.7%) よりもCSII (51.1%) とMDI (44.9%) グループで著しく高かった.
- HOMA-Bと急性インスリン応答によって示されたベータ細胞機能は,インスリン療法によって有意に改善され,1年後に持続しました.
結論:
- 早期の集中インスリン治療は,新たにT2Dと診断された患者で優れた結果を示しています.
- インスリン療法はベータ細胞の回復と維持を促進し,長期の血糖性寛解につながります.
- 暫定的なインセンティブインスリン療法は,T2Dの管理のために口服薬よりもより効果的な戦略を提供します.
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