摘要目的 探讨体重指数和餐后2h C肽增值[餐后2h C肽(2hCP)-空腹C肽(FCP)值]在血糖控制不佳2型糖尿病患者强化降糖后方案调整中的应用价值.方法 对156例血糖控制不佳的2型糖尿病患者,入院后行每日注谢4次胰岛素强化降糖治疗,血糖稳定后查胰岛功能,如空腹C肽(FCP)≥1 ng/ml,予改为口服降糖药加基础胰岛素治疗(方案A,A组),而FCP<1 ng/ml,则继续每日4次胰岛素强化治疗(方案B,B组).采用方案A患者如1周后空腹血糖(FPG)、餐后2 h血糖(2hPG)未达标,改用方案B(归入B组).比较2组患者基线资料如:性别、年龄、糖尿病病程、体重指数(BMI)、FPG、2hPG、HbA1C、三酰甘油(TG)、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、FCP、2hCP、2hCP/FCP、餐后2h C肽增值.并对2组患者分组时及治疗1个月后胰岛素剂量、低血糖发生率、血糖达标率进行比较.结果 A组患者BMI、TG、FCP、2hCP、2hCP/FCP及餐后2h C肽增值高于B组(P<0.01),而FPG、2hPG与HbA1C低于B组(P<0.01).分组时,2组胰岛素剂量、低血糖发生率、FPG与2hPG达标率无明显差异;治疗1个月后,A组胰岛素剂量、低血糖发生率明显少于B组,FPG、2hPG达标率好于B组(P<0.05或P<0.01).二元logistic回归分析结果显示,BMI与餐后2h C肽增值为选择降糖方案A的独立相关因素(β=0.26、0.90,P<0.01).受试者工作特征曲线显示BMI与餐后2h C肽增值曲线下面积分别为0.72、0.84(P<0.01),预测选择降糖方案A切点值分别为23.14 kg/m2、1.32 ng/ml.结论 在血糖控制不佳2型糖尿病患者中,BMI、餐后2h C肽增值可以作为降糖方案选择的预测指标.

abstractsObjective To explore the application of body mass index(BMI)and the increased value of postpradial 2h C peptide [2hCP minus fasting C-peptide(FCP), ΔCP]as indexes to adjust the antidiabetic plan after intensive blood glucose control in poorly controlled patients with type 2 diabetes mellitus(T2DM).Methods The insulin intensive therapy with injections of insulin four times a day was applied to 156 type 2 diabetic in-patients with poorly glycemic control.Islet function was evaluated after glucostasis in all patients.According to FCP≥1 ng/ml, addition of basal insulin to oral antidiabetic drugs was applied(as plan A, A group).The insulin intensive therapy was continued if FCP<1ng/ml(as plan B,B group).The treatment plan was adjusted from plan A to B when plasma glucose was poorly controlled after a week(as B group).The baseline data of sex, age, diabetes duration, BMI, fasting plasma glucose(FPG), 2 hours postpradial plasma glucose(2hPG), HbA1C, triglyceride(TG), total cholesterol, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, FCP, 2hCP, 2hCP/FCP, and ΔCP were analyzed.Insulin dose, the incidence of hypoglycemia, and the targeted rate of glucose control were compared between two groups before grouping and one month after treatment.Results The results showed that BMI, TG, FCP, 2hCP, 2hCP/FCP, and ΔCP in A group were higher than those in B group(P<0.01), while FPG, 2hPG and HbA1C were lower(P<0.01).There were no differences in insulin dose, the incidence of hypoglycemia, the targeted rate of FPG and 2hPG between two groups when grouping.After one-month treatment, insulin dose and the incidence of hypoglycemia in group A were lower than those in group B, while the targeted rates of FPG and 2hPG in group A were better than group B(P<0.05 or P<0.01).The results of binary logistic regression analysis showed that BMI and ΔCP were independent factors for choosing antidiabetic plan A(β=0.26, 0.90,P<0.01).The areas under receiver operator characteristic curve of BMI and ΔCP were 0.72 and 0.84, respectively(P<0.01), and their cut-off points to choose antidiabetic plan A were 23.14 kg/m2 and 1.32 ng/ml.Conclusions BMI and ΔCP can be used as the predictive indexes for choosing an antidiabetic plan for poorly controlled type 2 diabetic patients.