【原创】2型糖尿病的“蜜月期”--糖尿病的治疗新思路和新目标！
发布于 2009-01-18 · 浏览 2.6 万 · IP 江苏江苏
这个帖子发布于 16 年零 123 天前，其中的信息可能已发生改变或有所发展。
1997年以色列Erol Cerasi医生首先提出了2型糖尿病的“蜜月期”的概念！他对13例新诊断2型糖尿病使用胰岛素治疗后，有9例不用胰岛素而维持良好血糖9—50个月。使用的方法：胰岛素泵2周。其中有的病例重复使用胰岛素泵2-3次！//有4例不能进入“蜜月期”。诱导进入“蜜月期”的几率为：69.23%
相关的回顾：
1、1996年美国Banerji MA医生在Diabetes. 1996 Mar;45(3):337-41.报道了：Long-term normoglycemic remission in black newly diagnosed NIDDM subjects. 一组79例新诊断2型糖尿病经过短期使用药物（包括胰岛素和磺脲类）治疗，完全停药后，在一定时期内自身血糖也控制的很好。
2、2004年中国翁建平医生在DIABETES CARE, VOLUME 27, NUMBER 11, NOVEMBER 2004.报道了：Induction of Long-term Glycemic Control in Newly Diagnosed Type 2 Diabetic Patients Is Associated With Improvement of B-Cell Function 一组126例新诊断2型糖尿病经过使用胰岛素泵治疗2周，完全停药后，在一定时期内自身血糖也控制的很好。提出了：胰岛素1相分泌的恢复是（“蜜月期”）缓解的原因！//有12例不能进入“蜜月期”。诱导进入“蜜月期”的几率为：91.30%
3、2007年中国李光伟医生 在《实用糖尿病杂志》2007年04期.报道了：新诊断2型糖尿病及其蜜月期
4、个案报告：新诊断2型糖尿病在应用强化胰岛素皮下注射可以取得同样的“蜜月期”疗效。
5、其他：新诊断2型糖尿病在应用磺脲类药物、双胍类、胰岛素增敏剂都可以取得同样的“蜜月期”疗效。这些病人往往有着惊人的爱好运动的习惯！
6、报告一个2型糖尿病的“蜜月期”病例：【原创】2型糖尿病之1480个日夜！(发布日期：2008-12-11)
http://www.dxy.cn/bbs/post/view?bid=92&id=13442595&sty=3&keywords=1480
使用的方法：胰岛素泵11天》》改为诺和灵30R共87天[餐前半小时皮下注射：由早：20U、晚18U；逐渐减量到早：8U、晚6U]（联合使用格华止500mg/天，计26天）每天坚持控制饮食、锻炼身体！FBS: 4.9mmol/L（2008-12-6）前面所列举的1-5中的研究，往往都是单项治疗对诱导“蜜月期”的影响！而本例患者的治疗恰恰体现了前述1-5个研究的一种组合！所以，对新诊断的2型糖尿病的新的治疗思路就是：为了最大程度的挽救胰岛素功能，实现胰岛素1相分泌功能的恢复，使出你最有力的一套“强力组合拳”--不达目的，誓不罢休！如果，患者经你的治疗不能被诱导进入“蜜月期”！要首先考虑还有那些的治疗不到位！
以下为患者在停用胰岛素后自测的164次FBS的分布趋势：
FBS<=4.6mmol/L........17次/164......10.36%
FBS<=5.0mmol/L........38次/164......23.17%
FBS<=5.6mmol/L......124次/164......75.61%
FBS<=6.1mmol/L......153次/164......93.29%
6.1<FBS<6.4...............7次/164.......4.26%
6.4<=FBS<=6.9..........4次/164.......2.43%
当FBS =4.6mmol/L时，内源性胰岛素分泌减少；所以，当空腹血糖3.9-4.6mmo/L时，可以认为机体的胰岛素功能处在最好状态！机体对自身胰岛素的分泌需求量最少！需要合成的胰岛素的量也最少！同时，胰岛淀粉样多肽的产量也最少！胰岛Bcell所受到的来自胰岛淀粉样多肽的损伤也就最少！此时的胰岛Bcell最轻松！也最健康！这就是新诊断的2型糖尿病的新的治疗目标：空腹血糖3.9-4.6mmo/L.(不使用任何降糖药)
当FBS =5.0mmol/L时，开始发生慢性高血糖毒性对β细胞功能的损伤作用。
当FBS =5.6mmol/L时，急性葡萄糖刺激胰岛素分泌反应开始下降。（即胰岛素I相分泌）这是通常我们临床上所能检测到的最早的提示胰岛素功能减退的指标。正常的急性葡萄糖刺激胰岛素分泌反应的特点是短时、快速、高浓度的胰岛素脉冲式分泌模式是控制餐后血糖基础。临床上经过胰岛素强化治疗的初诊初治的2型糖尿病人，进入“蜜月期”的根本前提条件就是急性葡萄糖刺激胰岛素分泌反应完全恢复！
当FBS =6.4mmol/L时，急性葡萄糖刺激胰岛素分泌反应完全消失。
当FBS =7.0mmol/L时，2型糖尿病的诊断切点。
新的治疗思路+新的治疗目标必将产生新的2型糖尿病的发作模式：新诊断2型糖尿病经过强力组合的强化治疗进入“蜜月期”10年、或者更长时间（甚至终身！），直到再次出现高血糖表现，再次给予强力组合的强化治疗进入“蜜月期”10年，如此重复循环！那样对于2型糖尿病来说，在其一生中，2型糖尿病的反复短期发作也就是2次、3次、4次、5次......就象一个普通感冒一样！
1997年以色列Erol Cerasi医生首先提出了2型糖尿病的“蜜月期”的概念:(摘要)
1: Diabetes Care. 1997 Sep;20(9):1353-6.
Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients by transient intensive insulin treatment.
Ilkova H, Glaser B, Tunçkale A, Bagriaçik N, Cerasi E.
Department of Internal Medicine, Istanbul University Cerrahpasa Medical Faculty, Turkey.
OBJECTIVE: Type 2 diabetes is a slowly progressive disease, in which the gradual deterioration of glucose tolerance is associated with the progressive decrease in beta-cell function. Hyperglycemia per se has deleterious effects on both beta-cell function and insulin action, which are partially reversible by the short-term control of blood glucose levels. We hypothesized that the induction of euglycemia, using intensive insulin therapy at the time of clinical diagnosis, could lead to a significant improvement in insulin secretion and action and thus alter the clinical course of the disease. RESEARCH DESIGN AND METHODS: Thirteen newly diagnosed diet-unresponsive type 2 diabetic patients were treated with continuous subcutaneous insulin infusion (CSII) for 2 weeks and followed longitudinally while being treated with diet alone. RESULTS: Four patients were considered therapeutic failures since CSII failed to induce euglycemia (n = 1) or glucose control deteriorated within 6 months after CSII (n = 3). The remaining nine patients were maintained on diet alone with adequate control from 9 to > 50 months (median +/- SE, 26 +/- 4.8 months). In five patients, glycemic control deteriorated after 9-36 months, but a repeat 2-week CSII treatment reestablished control in four patients. One of these patients underwent a third CSII treatment 13 months later. At the time this article was written, six patients of the initial group were still controlled without medication 16-59 months (median +/- SE, 45.5 +/- 6.6 months) after the initiation of treatment. Body weight remained unchanged in all patients. CONCLUSIONS: These findings suggest that in a significant proportion of type 2 diabetic patients who fail to respond to dietary measures, short-term intensive insulin treatment can effectively establish responsiveness, allowing long-term glycemic control without medication. Further studies are required to establish whether simpler treatment regimens could be equally effective. If the hypothesis offered here finds support, present approaches to the management of newly diagnosed type 2 diabetes may need to be revised.
PMID: 9283777 [PubMed - indexed for MEDLINE]
......以色列Erol Cerasi医生......
相关的回顾：
1、1996年美国Banerji MA医生在Diabetes. 1996 Mar;45(3):337-41.报道了：Long-term normoglycemic remission in black newly diagnosed NIDDM subjects. 一组79例新诊断2型糖尿病经过短期使用药物（包括胰岛素和磺脲类）治疗，完全停药后，在一定时期内自身血糖也控制的很好。
2、2004年中国翁建平医生在DIABETES CARE, VOLUME 27, NUMBER 11, NOVEMBER 2004.报道了：Induction of Long-term Glycemic Control in Newly Diagnosed Type 2 Diabetic Patients Is Associated With Improvement of B-Cell Function 一组126例新诊断2型糖尿病经过使用胰岛素泵治疗2周，完全停药后，在一定时期内自身血糖也控制的很好。提出了：胰岛素1相分泌的恢复是（“蜜月期”）缓解的原因！//有12例不能进入“蜜月期”。诱导进入“蜜月期”的几率为：91.30%
3、2007年中国李光伟医生 在《实用糖尿病杂志》2007年04期.报道了：新诊断2型糖尿病及其蜜月期
4、个案报告：新诊断2型糖尿病在应用强化胰岛素皮下注射可以取得同样的“蜜月期”疗效。
5、其他：新诊断2型糖尿病在应用磺脲类药物、双胍类、胰岛素增敏剂都可以取得同样的“蜜月期”疗效。这些病人往往有着惊人的爱好运动的习惯！
6、报告一个2型糖尿病的“蜜月期”病例：【原创】2型糖尿病之1480个日夜！(发布日期：2008-12-11)
http://www.dxy.cn/bbs/post/view?bid=92&id=13442595&sty=3&keywords=1480
使用的方法：胰岛素泵11天》》改为诺和灵30R共87天[餐前半小时皮下注射：由早：20U、晚18U；逐渐减量到早：8U、晚6U]（联合使用格华止500mg/天，计26天）每天坚持控制饮食、锻炼身体！FBS: 4.9mmol/L（2008-12-6）前面所列举的1-5中的研究，往往都是单项治疗对诱导“蜜月期”的影响！而本例患者的治疗恰恰体现了前述1-5个研究的一种组合！所以，对新诊断的2型糖尿病的新的治疗思路就是：为了最大程度的挽救胰岛素功能，实现胰岛素1相分泌功能的恢复，使出你最有力的一套“强力组合拳”--不达目的，誓不罢休！如果，患者经你的治疗不能被诱导进入“蜜月期”！要首先考虑还有那些的治疗不到位！
以下为患者在停用胰岛素后自测的164次FBS的分布趋势：
FBS<=4.6mmol/L........17次/164......10.36%
FBS<=5.0mmol/L........38次/164......23.17%
FBS<=5.6mmol/L......124次/164......75.61%
FBS<=6.1mmol/L......153次/164......93.29%
6.1<FBS<6.4...............7次/164.......4.26%
6.4<=FBS<=6.9..........4次/164.......2.43%
当FBS =4.6mmol/L时，内源性胰岛素分泌减少；所以，当空腹血糖3.9-4.6mmo/L时，可以认为机体的胰岛素功能处在最好状态！机体对自身胰岛素的分泌需求量最少！需要合成的胰岛素的量也最少！同时，胰岛淀粉样多肽的产量也最少！胰岛Bcell所受到的来自胰岛淀粉样多肽的损伤也就最少！此时的胰岛Bcell最轻松！也最健康！这就是新诊断的2型糖尿病的新的治疗目标：空腹血糖3.9-4.6mmo/L.(不使用任何降糖药)
当FBS =5.0mmol/L时，开始发生慢性高血糖毒性对β细胞功能的损伤作用。
当FBS =5.6mmol/L时，急性葡萄糖刺激胰岛素分泌反应开始下降。（即胰岛素I相分泌）这是通常我们临床上所能检测到的最早的提示胰岛素功能减退的指标。正常的急性葡萄糖刺激胰岛素分泌反应的特点是短时、快速、高浓度的胰岛素脉冲式分泌模式是控制餐后血糖基础。临床上经过胰岛素强化治疗的初诊初治的2型糖尿病人，进入“蜜月期”的根本前提条件就是急性葡萄糖刺激胰岛素分泌反应完全恢复！
当FBS =6.4mmol/L时，急性葡萄糖刺激胰岛素分泌反应完全消失。
当FBS =7.0mmol/L时，2型糖尿病的诊断切点。
新的治疗思路+新的治疗目标必将产生新的2型糖尿病的发作模式：新诊断2型糖尿病经过强力组合的强化治疗进入“蜜月期”10年、或者更长时间（甚至终身！），直到再次出现高血糖表现，再次给予强力组合的强化治疗进入“蜜月期”10年，如此重复循环！那样对于2型糖尿病来说，在其一生中，2型糖尿病的反复短期发作也就是2次、3次、4次、5次......就象一个普通感冒一样！
1997年以色列Erol Cerasi医生首先提出了2型糖尿病的“蜜月期”的概念:(摘要)
1: Diabetes Care. 1997 Sep;20(9):1353-6.
Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients by transient intensive insulin treatment.
Ilkova H, Glaser B, Tunçkale A, Bagriaçik N, Cerasi E.
Department of Internal Medicine, Istanbul University Cerrahpasa Medical Faculty, Turkey.
OBJECTIVE: Type 2 diabetes is a slowly progressive disease, in which the gradual deterioration of glucose tolerance is associated with the progressive decrease in beta-cell function. Hyperglycemia per se has deleterious effects on both beta-cell function and insulin action, which are partially reversible by the short-term control of blood glucose levels. We hypothesized that the induction of euglycemia, using intensive insulin therapy at the time of clinical diagnosis, could lead to a significant improvement in insulin secretion and action and thus alter the clinical course of the disease. RESEARCH DESIGN AND METHODS: Thirteen newly diagnosed diet-unresponsive type 2 diabetic patients were treated with continuous subcutaneous insulin infusion (CSII) for 2 weeks and followed longitudinally while being treated with diet alone. RESULTS: Four patients were considered therapeutic failures since CSII failed to induce euglycemia (n = 1) or glucose control deteriorated within 6 months after CSII (n = 3). The remaining nine patients were maintained on diet alone with adequate control from 9 to > 50 months (median +/- SE, 26 +/- 4.8 months). In five patients, glycemic control deteriorated after 9-36 months, but a repeat 2-week CSII treatment reestablished control in four patients. One of these patients underwent a third CSII treatment 13 months later. At the time this article was written, six patients of the initial group were still controlled without medication 16-59 months (median +/- SE, 45.5 +/- 6.6 months) after the initiation of treatment. Body weight remained unchanged in all patients. CONCLUSIONS: These findings suggest that in a significant proportion of type 2 diabetic patients who fail to respond to dietary measures, short-term intensive insulin treatment can effectively establish responsiveness, allowing long-term glycemic control without medication. Further studies are required to establish whether simpler treatment regimens could be equally effective. If the hypothesis offered here finds support, present approaches to the management of newly diagnosed type 2 diabetes may need to be revised.
PMID: 9283777 [PubMed - indexed for MEDLINE]
......以色列Erol Cerasi医生......
最后编辑于 2009-03-20 · 浏览 2.6 万
102 122 8
