2型糖尿病患者口服药失效应用不同剂型胰岛素联合格列美脲的疗效比较

目的探讨口服药物治疗失效的2型糖尿病患者,应用甘精胰岛素联合格列美脲治疗与门冬胰岛素30联合格列美脲治疗的疗效比较。方法选择我院门诊的2型糖尿病患者68例经口服药物治疗失效的病例。糖尿病病程>1年且≤10年及血糖控制不佳的患者,HbA1C>7%但≤10%,空腹血糖均≥7.0 mmol/L。记录患者的年龄、病程、身高体重,计算体重指数,测定空腹血糖,糖化血红蛋白(HbA1C)。随机分为两组,每组各34例:①甘精胰岛素+格列美脲组(Gla-Gli组),给予甘精胰岛素起始用量10 u/d,早餐前格列美脲2.0 mg/d,口服;②门冬胰岛素组30+格列美脲组(BIasp-Gli组),门冬胰岛素30起始用量早餐前6.0 u,晚餐前4.0 u,早餐前格列美脲2.0 mg/d,口服。每3 d监测患者空腹、早餐后2 h、午餐前、晚餐前、睡前血糖,并要求患者记录出现症状性低血糖、低血糖症,以及出现严重性低血糖的时间和频次。前8周,每周于门诊就诊,调整胰岛素剂量,格列美脲固定不变,此后每2周就诊,使血糖逐渐达标。要求患者治疗12周复诊,测量体重,计算体重指数,测定空腹血糖,HbA1C。结果治疗12周后,两组空腹血糖(9.4 mmol/L±2.1 mmol/L VS 6.9 mmol/L±1.1 mmol/L;9.6 mmol/L±1.8 mmol/L VS 6.8 mmol/L±1.3 mmol/L,P<0.05)、HbA1C(8.6%±1.3%VS 7.3%±0.6%;8.5%±1.2%VS 7.2%±0.5%,P<0.05)较治疗前明显降低。治疗后两组间的空腹血糖、HbA1C没有差异(P>0.05)。在开始胰岛素治疗的12周中,Gla-Gli组与BIasp-Gli组的达标率无差别(55.9%VS 58.8%,P>0.05),均能有效地降低血糖。两组的胰岛素用量,Gla-Gli组0.35 u/kg,BIasp-Gli组0.30 u/kg。但是,Gla-Gli组的轻度低血糖次数更少(2.12 VS 4.78,P<0.05)。结论对于口服药失效的2型糖尿病患者,甘精胰岛素联合格列美脲治疗与门冬胰岛素30联合格列美脲均能够有效降低血糖。但是,甘精胰岛素联合格列美脲治疗2型糖尿病,更加安全。

Comparison of Different Types of Insulin Added to Glimepiride as Initial Insulin Theraphy for the Patients with Ineffective Controlled by Oral Antidiabetic Agents

Objective To compare the effect and safety of adding once-daily basal insulin versus twice-daily premixed insulin added to glimepiride in type 2 diabetic patients with ineffective controlled by oral antidiabetic agents(OADs).Methods This is a clinical cohort study In a 12-week.68 cases of such patinets(HbA1C 7%~10%,fasting blood glucose≥7.0 mmol/L) were randomized into two groups,once-daily night insulin glargine plus glimepiride(Group Gla-Gli,n=34) or premixed insulin analog(Insulin aspart 30) plus glimepiride(Group BIasp-Gli,n=34) twice daily.Ages,duration,height,weight,FBG and HbA1C were recorded and measured in both groups.Insulin dosage was titrated to target value using a weekly forced-titration algorithm in the first 8 weeks and 2-week forced-titration algorithm in the last 4 weeks.After 12-week clinical trial,subsequent visit were requested for the weight,height,HbA1C and FBG of the patients.Results Mean HbA1c(8.6%±1.3% vs 7.3%±0.6%;8.5%±1.2% vs 7.2%±0.5%,P<0.05) and FBG(9.4 mmol/L±2.1 mmol/L vs 6.9 mmol/L±1.1 mmol/L;9.6 mmol/L±1.8 mmol/L vs 6.8 mmol/L±1.3 mmol/L,P<0.05) from baseline was significantly decreased than pretreatment in both groups,but there was no difference between two groups after 12 weeks.The patients of both groups reached the similar rate of standard-obtained without statistical difference(55.9% vs 58.8%,P>0.05).The final insulin dose in Group BIasp-Gli was less than in Group Gla-Gli(0.30 u/kg vs 0.35 u/kg),while the incidence rate of hypoglycemia was higher in Group BIasp-Gli than in Group Gla-Gli(2.12 vs 4.78,P<0.05).Conclusion Initiating insulin treatment by adding basal insulin glargine once daily to glimepiride treatment was safe and more effective than beginning twice-daily injections of Insulin aspart 30 added to glimepiride in type 2 diabetic patients inadequately controlled with OADs.