甘精胰岛素联合瑞格列奈治疗2型糖尿病的疗效观察

目的观察甘精胰岛素联合瑞格列奈治疗口服降糖药物血糖控制不佳2型糖尿病的疗效和安全性。方法将82例口服降糖药物血糖控制不佳2型糖尿病患者按1∶1随机分为治疗组（甘精胰岛素加瑞格列奈）和对照组（低精蛋白胰岛素加瑞格列奈）,比较两组治疗12周后的空腹血糖（FBG）和餐后2h血糖（2hBG）水平、糖化血红蛋白（HbA1c）达标率及治疗期间低血糖发生率。结果两组治疗12周后FBG、2hBG、HbA1c较治疗前均明显下降（P〈0.05）,但治疗后两组上述指标比较差异无统计学意义（P〉0.05）;两组HbA1c达标率分别为73.1%、70.7%（P〉0.05）。治疗组低血糖发生率低于对照组（P〈0.05）。结论甘精胰岛素联合瑞格列奈可有效控制口服降糖药物控制不佳的2型糖尿病患者的血糖,且低血糖特别是夜间低血糖发生率低。     

来得时（甘精胰岛素）治疗2型糖尿病疗效观察

目的：观察来得时（甘精胰岛素）治疗2型糖尿病的疗效。方法：选择60例采用饮食控制及口服降糖药物治疗血糖控制不满意的2型糖尿病病例,于晚睡前注射1次来得时（甘精胰岛素）治疗,分别于治疗前及治疗后观察空腹血糖（FBG）及糖化血红蛋白（HbA1c）的变化。结果：加用来得时治疗后,FBG、HbA1c均较之前有明显下降（P〈0.05）,且低血糖发生少。结论：口服降糖药物联合睡前注射来得时方案具有降糖作用佳,安全性良好的特点。     

甘精胰岛素与中效胰岛素治疗2型糖尿病患者的临床观察

目的 观察2型糖尿病患者在口服降糖药物血糖控制不佳时应用甘精胰岛素和中效胰岛素的疗效和安全性.方法 口服降糖药物血糖控制不佳的2型糖尿病患者62例,随机分为治疗组和对照组.治疗组 31例在口服降糖药基础上给予甘精胰岛素治疗,对照组31例在口服降糖药基础上给予中效胰岛素治疗.结果 治疗3个月后2组F B G、2h P G、H b A1c均较治疗前明显下降(P<0.05),治疗组的 FBG较对照组下降更为明显(P<0.05),治疗后HbA1c达到≤7%的比例 2组相近,但治疗组hbA1c达到≤7%且未发生夜间低血糖的比例更多(P<0.05).两组患者治疗后组间比较最大血糖波动幅度(LAGE)差异有统计学意义(P<0.05),而2hPG降低的幅度无显著性差异(P>0.05).治疗结束时两组的胰岛素用量比较差异无统计学意义(P>0.05),治疗组低血糖事件发生率低于对照组(P<0.05).结论 在口服降糖药物控制不良的2型糖尿病患者中每日1次甘精胰岛素联合口服降糖药物较中效胰岛素联合口服降糖药物治疗疗效佳、安全性更好.     

长效胰岛素加口服降糖药治疗NIDDM口服降糖药继发性失效的临床研究

为了探讨非胰岛素依赖型糖尿病（NIDDM）口服磺豚类（SU）药物继发性失效的治疗方法，本研究采用口服足量磺脲类降糖药物加晚餐前注射长效胰岛素治疗此组病人2个月，结果病人自觉症状完全消失，空腹及餐后2h血糖较治疗前明显下降，胰岛功能得到改善。因应用小剂量胰岛素避免了低血糖的发生，提示口服SU药物加晚餐前注射长效胰岛素联合疗法是一种既安全又有效的疗法。     

三种胰岛素应用方案治疗口服降糖药物血糖控制不佳2型糖尿病临床对比研究

目的:探讨中性鱼精蛋白锌胰岛素,甘精胰岛素及地特胰岛素应用方案治疗口服降糖药物血糖控制不佳2型糖尿病临床疗效及安全性差异。方法:研究对象选取我院2012年3月-2015年6月收治行口服降糖药物血糖控制不佳2型糖尿病患者共150例,以随机区组法分为A组,B组及C组,每组各50例,分别采用中性鱼精蛋白锌胰岛素,甘精胰岛素及地特胰岛素应用方案治疗,比较三组患者治疗前后血糖指标水平、胰岛素用量及低血糖发生率等。结果:三组患者治疗后血糖指标水平显著低于治疗前,差异有统计学意义(P0.05);三组患者治疗后血糖指标水平比较差异无统计学意义(P0.05);A组患者胰岛素用量显著多于B组、C组,差异有统计学意义(P0.05);A组患者低血糖发生率显著高于B组、C组,差异有统计学意义(P0.05)。结论:三种胰岛素应用方案治疗口服降糖药物血糖控制不佳2型糖尿病临床疗效接近,但甘精胰岛素和地特胰岛素应用可有效减少胰岛素用量,降低低血糖发生风险。     

诺和灵30R和甘精胰岛素对2型糖尿病的疗效观察

目的：评价诺和灵30R与甘精胰岛素用于治疗糖尿病的降糖作用和安全性。方法：64例应用口服降糖药血糖控制不佳的2型糖尿病患者[空腹血糖（FBG）≥10mmol／L）]按治疗方法分为诺和灵30R治疗组（33例）和甘精胰岛素治疗组（31例）。依照空腹血糖（FBG）水平调整胰岛素用量，治疗目标值FBG〈7．0mmol／L，治疗时间16周。观察治疗空腹血糖（fasting blood glucose，FBG）、糖化血红蛋白AlC（glycosylated hemoglobinAlC，GHbAlC）、体重变化及低血糖的情况。结果：治疗后2组患者的空腹血糖、餐后2h血糖均明显低于治疗前各组水平（P〈0．01）；诺和灵30R治疗组血糖下降水平与甘精胰岛素治疗组无差异（P〉0．05）；甘精胰岛素治疗组低血糖发生率明显低于诺和灵30R治疗组（P〈0．01），诺和灵30R治疗组和甘精胰岛素治疗组治疗前后BMI无明显差异（P〉0．05）。结论：诺和灵30R和甘精胰岛素能较好地控制2型糖尿病病人血糖，甘精胰岛素治疗组低血糖发生率明显低于诺和灵30R治疗组（P〈0．01），二者对病人体重影响小，具有安全、方便的特点，是2型糖尿病理想的治疗方案。     

口服降糖药联合甘精胰岛素治疗2型糖尿病的临床观察

目的观察甘精胰岛素联合口服降糖药治疗2型糖尿病（T2DM）的临床效果．方法对56例单用口服降糖药效果欠佳的T2DM患者早餐前加用甘精胰岛素治疗，分别于治疗前及治疗后观察空腹血糖（FPG）、餐后2h血糖（2hPG）、糖化血红蛋白（HbAIC）、空腹C肽（FCP）、餐后2hC肽（2hCP）、血脂、体重、血压的变化．结果早餐前加用甘精胰岛素治疗后FPG、2hPG、HbAIC较治疗前明显下降（P〈0．01），治疗后3个月FCP、2hCP较治疗前明显升高（P〈0．01），而对血脂、体重指数、血压影响不大，且无低血糖反应．结论口服降糖药物联合甘精胰岛素治疗方案具有降糖作用佳、安全性良好的特点．     

甘精胰岛素联合口服降糖药物治疗2型糖尿病48例有效性和安全性临床观察

目的：比较甘精胰岛素联合口服降糖药物与诺和灵30R治疗对型糖尿病的有效性和安全性。方法：2型糖尿病患者进行对照临床观察,甘精胰岛素组20例,诺和灵30R组28例,治疗12周。结果：①治疗12周,甘精胰岛素组与诺和灵30R组HbA1c分别下降1.07%和1.03%,餐后2小时血糖分别下降3.65mmol/L和3.43mmol/L,空腹血糖分别下降2.4mmol/L和2.2mmol/L,治疗前后均有明显变化（均P〈0.05）,但两组间比较差异无统计学意义（P〉0.05）。②低血糖事件发生率分别为10%和28.6%,均为轻度。结论：甘精胰岛素联合口服降糖药物是一种治疗2型糖尿病的有效、安全的胰岛素剂型。     

甘精胰岛素联合格列吡嗪控释片治疗2型糖尿病

目的探讨超长效重组甘精胰岛素与中效胰岛素联合口服格列吡嗪控释片治疗2型糖尿病的疗效比较。方法60例口服降糖药血糖控制不理想的2型糖尿病患者按1：1随机分为甘精胰岛素治疗组和诺和灵N组。观察血糖控制和低血糖事件发生频率，以及空腹血糖（FBG）达标时所用甘精胰岛素和诺和灵N的剂量。结果治疗后两组FBG及全天血糖谱均较基线水平明显下降，两组下降幅度比较差异无显著性，甘精胰岛素组HbAlc达标率（29．63％）明显高于诺和灵N组（5．28％）。甘精胰岛素组夜间低血糖发生率明显低于诺和灵N组。结论清晨口服长效降糖药联合睡前注射1次超长效甘精胰岛素可使更多控制不佳的2型糖尿病患者血糖达标，并能减少夜间低血糖发生。     

文迪雅治疗2型糖尿病的疗效观察

目的观察文迪雅治疗2型糖尿病疗效及副作用。方法入选36例2型糖尿病患者．所有病例均在饮食、运动疗法的基础上给予文迪雅4mg／qd或8mg／qd，联合应用其他口服降糖药者均保持原药物剂量不变。疗程12周。分别观察治疗前后空腹及餐后2h血糖、糖化血红蛋白、空腹及餐后2h血浆胰岛素、血脂、血常规的变化。结果（1）治疗前后空腹及餐后2h血糖、糖化血红蛋白、空腹及餐后2h血浆胰岛素、血压均明显下降具有显著差异；（2）甘油三脂、总胆固醇、低密度脂蛋白胆固醇轻度下降，高密度脂蛋白胆固醇轻度升高，但无显著差异；（3）治疗前后肝功能、肾功能、尿酸、血常规等均无明显改变。（4）不良反应：其中体重轻度增加（0．4～1，6kg）7例；Hb含量较治疗前有所下降（但仍在正常范围内）2例；双侧踝关节轻度水肿1例；联合应用磺脲类降糖药物者因未及时减量，发生低血糖反应2次。结论文迪雅可明显降低血糖、糖化血红蛋白和胰岛素水平，降低血压．具有减轻胰岛素抵抗、改善胰岛β细胞功能、全面控制2型糖尿病的作用，且服用方便，一日一次，不受进餐影响，患者依从性好，是一个高效、安全、副作用小的口服降糖药物。     

严格血糖控制对危重症炎症与免疫状态的影响

目的了解创伤、感染等应激后重症病人血清CRP(C反应蛋白)、IL-6(白细胞介素-6)、MIF(巨噬细胞移动抑制因子)及外周血单核细胞人类白细胞抗原(HLA-DR)的变化及其与应激性高血糖的相互关系;探讨强化胰岛素治疗对重症病人体内炎症反应与免疫状态的影响。方法33例收住SICU的重症病人分为3组:血糖控制1组(目标血糖4.44~6.11mmol/L),血糖控制2组(目标血糖6.66~8.33mmol/L),对照组(目标血糖9.99~11.10mmol/L),入选后第1、4、7天测定外周血单核细胞HLA-DR及血清IL-6、MIF、CRP的动态变化。结果3组病人血清CRP、IL-6、MIF均明显升高,CRP与血糖水平呈正相关(P<0.05);外周血单核细胞HLA-DR降低,与血糖水平呈负相关(P<0.05)。强化胰岛素治疗后,血糖控制1组与对照组相比,血清CRP、IL-6在第7天显著下降(P<0.05),血清MIF的下降与对照组差异无统计学意义(P>0.05),而HLA-DR明显高于同期对照组水平(P<0.05)。结论强化胰岛素治疗将血糖控制于正常水平更有助于增加外周血单核细胞表面HLA-DR的表达,下调应激后重症病人机体内炎症反应状态。     

乙肝后肝硬化患者血清ghrelin、瘦素与胰岛素抵抗的关系

目的:探讨乙肝后肝硬化患者ghrelin、瘦素(Leptin)水平变化规律及其与胰岛素抵抗的关系。方法:选择乙肝后肝硬化患者100例,按肝功能Child A、B、C 3级分组,正常对照组36例,测定各组空腹血糖(FPG)、空腹胰岛素(FINS)、ghrelin及Leptin指标,计算胰岛素抵抗指数(IRS)并进行对比分析。结果:乙肝后肝硬化患者FPG、FINS、IRS、Leptin水平高于对照组,ghrelin水平低于对照组,差异有统计学意义(P<0.01);肝硬化患者A级、B级、C级三组之间FINS、IRS、ghrelin、Leptin差异有统计学意义(P<0.01),FINS、IRS、leptin水平随Child分级升高而升高(P<0.05),ghrelin水平随Child分级的升高而降低(P<0.05)。结论:ghrelin和Leptin水平的变化与乙肝后肝硬化患者的胰岛素抵抗密切相关,ghrelin和瘦素水平的测定对肝硬化病情严重程度的评价有重要临床价值。     

肝硬化并发胃粘膜损伤的研究

目的　研究肝硬化并发胃粘膜损伤情况。方法　对 1 95例门诊及住院的肝硬化患者常规进行胃镜检查 ,并对不同肝功能水平患者胃粘膜损伤情况进行分析。结果　 1 95例肝硬化患者中糜烂性胃炎 1 0 5例 (53 84% )、消化性溃疡 66例 (33 8% )、食管 -胃底静脉曲张 1 65例 (84 6 % )。根据Child-pugh分级将肝功能分为A、B、C三级 ,肝功能级别与胃粘膜损伤发生率之间存在一定的线性依从关系 (P <0 0 5)。结论　胃粘膜损伤发生率有随肝功能分级增高而上升的趋势 ,对肝硬化患者应常规进行胃镜检查     

高血糖与急性脑梗塞的关系

将97例老年急性脑梗塞患者根据病史和入院3天内血糖测定分为糖尿病组、非糖尿病血糖升高组和非糖尿病血糖正常组。前二组又按血糖水平分为血糖轻度升高和血糖显著升高两种,然后对三组患者的临床症状、体征、脑CT改变及预后等进行对比分析。结果表明:急性脑梗塞患者,无论是糖尿病或是应激性高血糖引起的显著血糖升高者,均可使临床症状和肢体瘫痪加重,大面积梗塞和严重并发症增多,脑机能恢复不良和病死率增高;而糖尿病组和轻度血糖升高者仅造成病死率增高和脑机能恢复不良。提示血糖水平可作为急性脑梗塞患者预后的指标。     

肝硬化患者糖代谢、血清胰岛素及胰高血糖素的变化

目的观察肝硬化患者糖代谢变化,探讨其可能机制与肝储备功能的关系。方法 46例肝硬化患者进行口服糖耐量试验、胰岛素释放试验及胰高血糖素的测定,并与同期住院36例非肝病患者进行比较。结果肝硬化组和对照组空腹血糖均正常,分别为（5.0±2.8）mmol/L和（4.9±1.9）mmol/L（P〉0.05）;餐后2h,肝硬化组血糖为（10.4±5.2）mmol/L,对照组血糖为（7.8±2.2）mmol/L,肝硬化组血糖升高更为明显（P〈0.05）。两组空腹血清胰岛素均正常,分别为（17.2±6.3）Um/L和（10.2±7.0）Um/L（P〉0.05）;餐后2h,肝硬化组胰岛素为（55.9±11.2）Um/L,对照组胰岛素为（35.7±12.2）Um/L,肝硬化组胰岛素升高更为明显（P〈0.05）。肝硬化患者胰高血糖素较对照组明显增高,分别为（256.14±76.1）ng/L和（67.9±26.6）ng/L（P〈0.05）。结论肝硬化患者糖代谢异常,且随肝功损害加重,胰高血糖素增高,提示胰岛素抵抗参与其发生过程。     

Addition of sulfonylurea to insulin treatment in poorly controlled type II diabetes. A double-blind, randomized clinical trial

This study examined the potential beneficial effects of the addition of a second-generation sulfonylurea to insulin therapy for poorly controlled type II diabetes. A randomized, double-blind, crossover experimental design was utilized in 16 type II diabetic patients for a period of eight months. Treatment with glyburide, 20 mg/d (plus insulin), compared with placebo (plus insulin) resulted in a significant reduction in mean basal glucose (232 +/- 12 vs 262 +/- 11 mg/dL [12.8 vs 14.4 mmol/L]) and hemoglobin A1C (10.2% +/- 0.5% vs 10.9% +/- 03%) concentrations. Concomitant with this change, basal C-peptide and free insulin values increased with glyburide therapy, but this pharmacological agent did not alter the ability of the patient's erythrocytes to bind insulin. We conclude that in type II diabetic subjects receiving more than 28 units of insulin per day, the addition of glyburide results in a marginal, but statistically significant improvement in basal glucose concentration, but not in glucose tolerance as assessed by integrated glucose concentration. Whether this small improvement in glycemia is worth the additional cost of sulfonylureas or the risk of drug side effects is not known.     

The clinical use of oral sulfonylureas in the management of non-insulin dependent diabetes mellitus (NIDDM)

Eighty percent of Americans afflicted with diabetes mellitus have Type II or non-insulin dependent diabetes mellitus (NIDDM). Impaired or defective insulin secretion and insulin resistance are universal pathophysiologic findings. Management involves attention to diet, exercise, and commonly the use of insulin and/or oral sulfonylureas. Currently there are six marketed first and second generation agents available for use in the United States. Although the newer agents are more potent, they all share a similar mechanism of action. These agents can only be effective if the patient has retained beta cell secretory function. Pharmacokinetic and pharmacodynamic differences may make the newer agents, glyburide and glipizide, preferred in the management of Type II diabetes mellitus. The combined use of insulin and oral sulfonylureas may be useful for the patient exhibiting persistent fasting hyperglycemia despite maximal oral drug therapy. The precise role for combination therapy and optimal patient characteristics awaits further study.     

在非胰岛素依赖型糖尿病中优降糖和中草药CMH疗效评价对比

本文采用随机双盲法观察优降糖和/或中草药 CMH 治疗糖尿病的疗效。40例非胰岛素依赖型糖尿病患者随机分成4组,A 组予安慰剂,B 组予优降糖,C 组予优降糖和 CMH,D 组予 CMH,疗程为三个月。研究结果表明:(1)优降糖能降低果糖胺、空腹和餐后血糖水平,提高餐后1小时胰岛素水平。(2)CMH 能降低果糖胺和空腹血糖水平。(3)优降糖和 CMH 合用无明显毒副作用,且降糖效果更强。     

Effect of intravenous infusion of insulin in diabetics with acute myocardial infarction

Diabetes mellitus is associated with a high mortality after myocardial infarction. To see whether this may be decreased by improved diabetic control the effect of an insulin infusion regimen was studied in patients with acute myocardial infarction. From April 1982 to April 1983, 33 diabetics were admitted with acute myocardial infarction. Those being treated with diet alone or oral hypoglycaemic drugs continued with this unless control was poor, when they were changed to a "sliding scale" regimen of subcutaneous insulin injections thrice daily. Those already receiving insulin were maintained on thrice daily subcutaneous injections. From April 1983 to April 1984, 29 diabetics had acute myocardial infarction. Those receiving treatment with oral hypoglycaemic drugs or insulin were changed to continuous intravenous infusion of insulin, the aim being to maintain the blood glucose concentration at 4-7 mmol/I (72-126 mg/100 ml). Those being treated with diet alone continued with this if blood glucose concentrations were acceptable. Total mortality fell from 42% in the first year to 17% in the second (p less than 0.05). Over the same period mortality among non-diabetic patients with myocardial infarction did not change significantly. There was a significant fall in cardiac arrhythmias (expressed as the percentage of patients in whom arrhythmias were recorded) from 42% to 17% (p less than 0.05). The most significant fall in the incidence of complications occurred in those who had been receiving oral hypoglycaemic drugs on entry to the study (87% to 50%, p less than 0.05).     

Therapy in type 2 diabetes: insulin glargine vs. NPH insulin both in combination with glimepiride

BACKGROUND: Type 2 diabetes (T2DM) patients often fail to achieve adequate glycemic control with oral antidiabetic drugs (OADs). Insulin has been shown to improve glycemic control in these patients but with increased risk of hypoglycemia. This study compared the efficacy and safety of insulin glargine and NPH insulin, both in combination with a once-daily fixed dose of glimepiride, in terms of glycemic control and incidence of hypoglycemia. METHODS: In this open-label, 24-week randomized trial in ten Latin American countries, T2DM patients poorly controlled on OADs (HbA1c > or = 7.5 and < or = 10.5%) received glimepiride plus insulin glargine (n = 231) or NPH insulin (n = 250) using a forced titration algorithm. The primary endpoint was the equivalence of 24-week mean changes in HbA1c. RESULTS: Insulin glargine and NPH insulin achieved similar HbA1c reductions (adjusted mean difference -0.047; 90% CI -0.232, 0.138; per-protocol analysis). Confirmed nocturnal hypoglycemia was significantly lower with insulin glargine vs. NPH insulin (16.9 vs. 30.0%; p <0.01; safety analysis). Patients receiving insulin glargine were significantly more likely to achieve HbA1c levels < 7.0% without hypoglycemia (27 vs. 17%; p = 0.014; per-protocol analysis). There was a more pronounced treatment satisfaction improvement with insulin glargine vs. NPH insulin (p <0.02; full analysis). The proportion of patients who lost time from work or normal activities due to diabetes was lower with insulin glargine vs. NPH (1.8 vs. 3.3%; full analysis). CONCLUSIONS: In patients with T2DM, inadequately controlled on OADs, once-daily insulin glargine plus glimepiride is effective in improving metabolic control with a reduced incidence of nocturnal hypoglycemia compared with NPH insulin.