胰岛素泵联合动态血糖监测系统短期治疗初发2型糖尿病疗效及安全性观察

目的评价持续皮下胰岛素输注与动态血糖监测系统联合应用方案的疗效及安全性。方法120例新诊断T2DM患者随机分为3组：双C组、单纯CSII组、每日多次注射胰岛素组。双C组行CGMS连续监测血糖，后两组均采用指尖血糖仪监测血糖。比较3组治疗3d时的平均血糖波动幅度及各组强化治疗2周后血糖控制情况、血糖达标时间、胰岛素用量、低血糖发生情况。结果（1）空腹血糖：强化治疗后3组均明显下降，组内差异均有统计学意义（P〈0．01），组间差异无统计学意义（P〉0．05）。（2）餐后2h血糖：强化治疗后3组均明显下降（P〈0．01），与CSII组、MDI组相比，双C组下降更明显（P〈0．01），CSII组、MDI组相比差异不显著（P〉0．05）。（3）血糖漂移：双C组MAGE显著低于CSII组及MDI组（P〈0．05），而后两组间差异无统计学意义（P〉0．05）。（4）血糖达标时间：双C组和CSII组明显短于MDI组，差异有统计学意义（P〈0．01）。（5）血糖达标时胰岛素用量：双C组少于CSII组及MDI组（P〈0．01），CSII组与MDI组相比差异不显著（P〉0．05）。（6）低血糖发生的次数：双C组少于CSII组与MDI组（P〈0．01）。结论3组对2型糖尿病患者强化降糖治疗均有效，短期应用CSII治疗效果好于MDI治疗，在CGMS监测下的CSII降糖治疗效果更好，达标所需时间短，胰岛素需用量少，低血糖事件少。

The efficacy and security of combined application of continuous subcutaneous insulin infusion and continuous glucose monitoring system for short-term insulin intensive treatment in patients with newly diagnosed type 2 diabetes mellitus

Objective To investigate the efficacy and security of strategy in which continuous subcutaneous insulin infusion are applied with continuous glucose monitoring system. Methods One hundred and twenty newly diagnosed patients with T2DM were divided into＂double C＂group, CSII group and multiple daily insulin injection group. All the patients are received for intensive treatment of two weeks. Data of CGMS was downloaded to direct the insulin dose adjustment of CSII in ＂double C＂ group. The dosage adjustment of CSII group and MDI group were according to finger blood glucose monitoring eight times a day. The first three days average margin of glucose extention, the changes of blood glucose before and after treatment, the time needed for obtaining satisfying control of blood glucose, the daily dose of insulin needed and the incidences of hypoglycaemia in each group were recorded for comparison. Results （ 1 ） The fasting blood glucose levels in every group decreased significantly（ P〈0. 01 ）after intensive treatment and no significant difference was observed among the three groups（ P〉0. 05）. （2）The 2-hour postprandial blood glucose in the three groups all decreased significantly too （ P 〈 0.01 ）. There was statistical difference between ＂double C＂group and the other two groups（ P〈0. 01）. But there was no statistical difference between CSII group and MDI group（ P〉0. 05）when the range of decrease of P2hBG was concerned. （3）The first three days average margin of glucose extention： ＂double C＂group is less than CSII group and MDI group（ P〈 0.05） ,while there is no significant difference between CSII group and MDI group（P〉0.05）. （4）The time of ＂double C＂group and CSII group needed to achieve standard blood glucose is significantly shorter than MDI group （ P〈0.01 ）. （ 5 ） When blood glucose reached the target, the daily insulin dose of ＂double C＂group is less than that of CSII group and MDI group（ P〈0.01 ）, while there is no statistical difference between CSII group and MDI group （P〉0.05）. （6）The incidences of hypoglycemia were significantly fewer in ＂double C＂group than any other group （ P〈0.01 ）. Conclusion ＂Double C＂,CSII and MDI therapy were all effective in making blood glucose to reach the goals in a short time in patients with newly diagnosed T2DM. ＂Double C＂strategy shows the best therapeutic efficacy with the shortest time needed, the least daily dose of insulin and the lowest incidence of hypoglycemia.