2型糖尿病胰岛素强化治疗时不同方案比较

目的:比较3种胰岛素强化治疗方案对2型糖尿病的血糖控制作用.方法:68例2型糖尿病患者随机分为3组,21例采用一天两次注射预混胰岛素+二甲双胍或阿卡波糖方案(Mix组),21例实行三短一长多次皮下注射胰岛素方案(MDI组),26例接受胰岛素泵方案(CSII组),待血糖平稳后胰岛素泵方案组改为3+1方案.观察各组患者血糖达到目标值所需要的胰岛素剂量、时间、血糖波动幅度、低血糖的发生情况和胰岛素泵改成多次皮下注射胰岛素方案后达稳态水平所需的胰岛素剂量、时间及血糖波动.结果:①MDI组、CSII组达标时间、血糖波动小于Mix组.②治疗7d时MDI组与CSII组相比全天各时间点血糖水平差异均无统计学意义;而Mix组中餐后血糖明显高于MDI组与CSII组,睡前及夜间2:00血糖则明显低于MDI组.③CSII组低血糖发生率明显低于Mix组和MDI组.④CSII组改为MDI方案后胰岛素用量及血糖波动幅度无明显变化.结论:胰岛素泵和MDI治疗方案控制血糖的效应相似;一天两次预混胰岛素结合药物治疗可以减少胰岛素用量,但低血糖发生率相对较高,血糖波动幅度较大,中、晚餐后血糖控制欠理想.

Comparison of different regimes of intensive insulin therapy in type 2 diabetes

Objective: To compare three regimes of intensive insulin therapy on the control functions in type 2 diabetes.Methods: Sixty-eight cases of type 2 diabetic patients were randomly divided into three groups,treated with premixed insulin injection,twice a day,with metformin or acabose(Mix group),multiple daily injection(MDI group) and continuous subcutaneous insulin infusion(CSII group).When CSII group achieved the target goal,the mode of treatment switched to MDI.Dosage of insulin,therapeutic time,fluctuation of blood glucose and occurrence of hypoglycemia were compared among the three groups before and after treatment.After MDI therapy of the third group,dosage of insulin,therapeutic time and fluctuation of blood glucose in each period were also recorded for comparison.Results:Therapeutic time and fluctuation of blood glucose in MDI group and CSII group were less than that in Mix group.In the 7th day after treatment,there was no significant difference of blood glucose level at all time points a day between MDI group and CSII group;the blood glucose of Mix group after lunch was obviously higher than that in MDI group and CSII group,but the blood glucose of bedtime and 2 o’clock at midnight was significantly lower than that in MDI group.Occurrence of hypoglycemia in CSII group was obviously lower that in Mix group and MDI group.There was no significant difference in insulin dosage and fluctuation of glucose level between CSII and MDI in the third group.Conclusion: The efficacy between CSII and MDI is similar.Premixed insulin injection twice a day with drug therapy can reduce the insulin dosage,but occurrence of hypoglycemia is relatively higher,fluctuation of blood glucose is large and blood glucose control after lunch and dinner is not satisfied.