三种胰岛素降糖方案治疗住院2型糖尿病的临床观察
摘要
目的
分析住院2型糖尿病患者短效人胰岛素联合中效鱼精蛋白锌胰岛素、预混型精蛋白锌重组人胰岛素70/30与双时相门冬胰岛素30三种胰岛素方案的血糖达标、血糖波动、胰岛素用量、住院日和低血糖情况,比较其有效性及安全性,评价三种胰岛素方案的优缺点及适合人群。
方法
采用回顾性分析方法,收集2008年3月至2009年8月在汕头大学医学院第一附属医院内分泌科住院的184例符合入选条件的2型糖尿病患者临床资料,按照住院时采用的胰岛素降糖方案将患者分为强化治疗组、预混胰岛素组、类似物胰岛素组。根据监测的末梢毛细血管全血血糖值统计三种胰岛素方案全天血糖达标率、血糖达标所需时间、低血糖发生频率,分析其低血糖时间点分布,同时比较出院时胰岛素总量及住院总天数。
结果
胰岛素类似物组全天血糖达标率低于强化治疗组及预混胰岛素组,有显著性差异(P<0.05)。强化治疗组全天血糖波动及空腹血糖波动较其余两组高,预混胰岛素组全天血糖波动最小,胰岛素类似物组空腹血糖波动最小。强化治疗组住院日较胰岛素类似物组短,有显著性差异(P<0.01)。强化治疗组低血糖发生频率及严重低血糖比例较其余两组高,胰岛素类似物组低血糖发生频率在三组中最低。强化治疗组监测的各时间点均容易发生低血糖。
结论
对于单纯使用胰岛素治疗的住院2型糖尿病患者,强化治疗适合对血糖控制较严格、要求节省住院日并且能够配合每天多次胰岛素注射的糖尿病患者使用,但要注意低血糖风险;预混型精蛋白锌重组人胰岛素70/30适合全天血糖波动较大的糖尿病患者;双时相门冬胰岛素30是本研究资料中较安全的胰岛素用药方案。
Objective
To compare the effects and safety of protamine zinc insulin, Isophane Protamine Recombinant Human Insulin Injection(Pre-mixed 30/70), and biphasic insulin aspart(BIAsp30)in patients with type 2 diabetes according to the blood glucose control,blood glucose fluctuations,insulin dosage, hospital stay and hypoglycemia.
Method
Cases were collected from March 2008 to August 2009 at Department of Endocrinology in the First Affiliated Hospital of Shantou University Medical College. 184 patients with type 2 diabetes met the selection criteria. Based on the insulin programmed preformed at admission, patients were divided into the intensive therapy group, premixed insulin group and insulin analogues group. According to the peripheral whole blood, three kinds of treatment were compared by day targets of glycemic control, the time required for blood glucose control, hypoglycemia frequency, to analyze the time distribution of low blood sugar, total quantity of insulin and total hospitalization days.
Result
Blood glucose control in one day was lower in insulin analogue group than other two groups (p<0.05). Fluctuations in all-day blood glucose and fasting blood glucose were highest in intensive therapy group, while fasting blood glucose fluctuations is lowest in premixed insulin group. Fluctuations in all-day blood glucose were lowest in analogue group. The length of hospital stay in insulin intensive therapy group was significantly shorter than that in insulin analogue group (P<0.01). Frequency of severe hypoglycemia and the ration of severe low blood sugar in insulin intensive therapy group were highest, while insulin analogue group were the lowest. Patients in insulin intensive therapy group were prone to hypoglycemia at any time in a day.
Conclusion
Insulin intensive therapy is suitable for type 2 diabetes patients who require more strict in blood glucose control and can assort multiple daily insulin injections,but caution the risk of hypoglycemia. Mixed Protamine Zinc Recombinant Human Insulin Injection is suitable for the patients with wider blood glucose fluctuations throughout the day. Insulin Aspart 30 Injection is a relatively safety insulin treatment program in our research.
分析住院2型糖尿病患者短效人胰岛素联合中效鱼精蛋白锌胰岛素、预混型精蛋白锌重组人胰岛素70/30与双时相门冬胰岛素30三种胰岛素方案的血糖达标、血糖波动、胰岛素用量、住院日和低血糖情况,比较其有效性及安全性,评价三种胰岛素方案的优缺点及适合人群。
方法
采用回顾性分析方法,收集2008年3月至2009年8月在汕头大学医学院第一附属医院内分泌科住院的184例符合入选条件的2型糖尿病患者临床资料,按照住院时采用的胰岛素降糖方案将患者分为强化治疗组、预混胰岛素组、类似物胰岛素组。根据监测的末梢毛细血管全血血糖值统计三种胰岛素方案全天血糖达标率、血糖达标所需时间、低血糖发生频率,分析其低血糖时间点分布,同时比较出院时胰岛素总量及住院总天数。
结果
胰岛素类似物组全天血糖达标率低于强化治疗组及预混胰岛素组,有显著性差异(P<0.05)。强化治疗组全天血糖波动及空腹血糖波动较其余两组高,预混胰岛素组全天血糖波动最小,胰岛素类似物组空腹血糖波动最小。强化治疗组住院日较胰岛素类似物组短,有显著性差异(P<0.01)。强化治疗组低血糖发生频率及严重低血糖比例较其余两组高,胰岛素类似物组低血糖发生频率在三组中最低。强化治疗组监测的各时间点均容易发生低血糖。
结论
对于单纯使用胰岛素治疗的住院2型糖尿病患者,强化治疗适合对血糖控制较严格、要求节省住院日并且能够配合每天多次胰岛素注射的糖尿病患者使用,但要注意低血糖风险;预混型精蛋白锌重组人胰岛素70/30适合全天血糖波动较大的糖尿病患者;双时相门冬胰岛素30是本研究资料中较安全的胰岛素用药方案。
Objective
To compare the effects and safety of protamine zinc insulin, Isophane Protamine Recombinant Human Insulin Injection(Pre-mixed 30/70), and biphasic insulin aspart(BIAsp30)in patients with type 2 diabetes according to the blood glucose control,blood glucose fluctuations,insulin dosage, hospital stay and hypoglycemia.
Method
Cases were collected from March 2008 to August 2009 at Department of Endocrinology in the First Affiliated Hospital of Shantou University Medical College. 184 patients with type 2 diabetes met the selection criteria. Based on the insulin programmed preformed at admission, patients were divided into the intensive therapy group, premixed insulin group and insulin analogues group. According to the peripheral whole blood, three kinds of treatment were compared by day targets of glycemic control, the time required for blood glucose control, hypoglycemia frequency, to analyze the time distribution of low blood sugar, total quantity of insulin and total hospitalization days.
Result
Blood glucose control in one day was lower in insulin analogue group than other two groups (p<0.05). Fluctuations in all-day blood glucose and fasting blood glucose were highest in intensive therapy group, while fasting blood glucose fluctuations is lowest in premixed insulin group. Fluctuations in all-day blood glucose were lowest in analogue group. The length of hospital stay in insulin intensive therapy group was significantly shorter than that in insulin analogue group (P<0.01). Frequency of severe hypoglycemia and the ration of severe low blood sugar in insulin intensive therapy group were highest, while insulin analogue group were the lowest. Patients in insulin intensive therapy group were prone to hypoglycemia at any time in a day.
Conclusion
Insulin intensive therapy is suitable for type 2 diabetes patients who require more strict in blood glucose control and can assort multiple daily insulin injections,but caution the risk of hypoglycemia. Mixed Protamine Zinc Recombinant Human Insulin Injection is suitable for the patients with wider blood glucose fluctuations throughout the day. Insulin Aspart 30 Injection is a relatively safety insulin treatment program in our research.
引文
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[2] Del Prato S,Tiengo A. The importance of first-phase insulin secretion: implications for the therapy of type 2 diabetes mellitus[J]. Diabetes Metab Res Rev,2001,17(3):164-174. PMID:11424229
[3] Yki-J?rvinen H. Acute and chronic effects of hyperglycaemia on glucose metabolism[J]. Diabetologia,1990,33(10):579-585. PMID:2257995
[4] Li YB,Xu W,Liao ZH,et al. Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients is associated with improvement of beta-cell function[J]. Diabetes care,2004,27(11):2597-2602. PMID:15504992
[5] Ryan EA,Imes S,Wallace C. Short-term intensive insulin therapy in newly diagnosed type 2 diabetes[J]. Diabetes Care,2004,27(5):1028-1032. PMID:15111515
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