2型糖尿病患者的胰岛素治疗方案选择

目的探讨2型糖尿病患者应用胰岛素治疗方案的选择。方法对临床60例2型糖尿病患者采用胰岛素治疗临床资料分析。结果 60例患者经治疗血糖均控制在理想范围。结论糖尿病发病率呈逐年升高趋势,胰岛素的治疗占重要地位。     

预混胰岛素血糖控制不佳2型糖尿病患者采用利拉鲁肽联合甘精胰岛素治疗的临床体会

目的对应用甘精胰岛素与利拉鲁肽联合对预混胰岛素血糖控制不佳2型糖尿病患者实施治疗的临床效果进行研究。方法将我院收治的92例预混胰岛素血糖控制不佳2型糖尿病患者随机分为对照组和治疗组,平均每组46例。采用甘精胰岛素与阿卡波糖联合对对照组患者实施治疗;采用甘精胰岛素与利拉鲁肽联合对治疗组患者实施治疗。结果治疗组患者预混胰岛素血糖控制不佳2型糖尿病治疗效果明显优于对照组;血糖水平恢复正常时间和临床治疗方案实施总时间明显短于对照组;用药治疗前后FPG、2h PG、Hb A1c水平的改善幅度明显大于对照组;药物不良反应人数明显少于对照组。结论应用甘精胰岛素与利拉鲁肽联合对预混胰岛素血糖控制不佳2型糖尿病患者实施治疗的临床效果非常明显。     

文摘

二甲双胍联合利拉鲁肽＋胰岛素序贯方案治疗2型糖尿病 一项多国研究报告,在二甲双胍治疗血糖控制不佳的2型糖尿病患者中,序贯加用利拉鲁肽和地特胰岛素的强化治疗方案可被多数患者耐受,患者血糖控制佳、体重持续减轻且低血糖发生率低。     

速读

二甲双胍联合利拉鲁肽+胰岛素序贯方案治疗2型糖尿病一项多国研究报告,在二甲双胍治疗血糖控制不佳的2型糖尿病患者中,序贯加用利拉鲁肽和地特胰岛素的强化治疗方案可被多数患者耐受,患者血糖控制佳、体重持续减轻且低血糖发生率低。该研究纳入988例二甲双胍治疗血糖控制不佳的2型糖尿     

地特胰岛素联合二甲双胍治疗老年患者2型糖尿病的疗效观察

目的观察地特胰岛素联合二甲双胍对老年患者2型糖尿病血糖的影响。方法对采用地特胰岛素联合二甲双胍(观察组,n=40)和诺和灵30R(对照组,n=40)治疗的80例2型糖尿病老年患者的临床资料进行回顾性分析。结果观察组患者的观察组患者的空腹血糖(FPG)、早餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)、胰岛素用量、体重指数(BMI)和低血糖事件发生都有明显改善,显著优于对照组(P<0.05),并且观察组的疗效也显著地优于对照组(P<0.05)。结论地特胰岛素联合二甲双胍能较好地控制2型糖尿病老年患者的血糖,并且低血糖发生率低,疗效好,是治疗老年2型糖尿病的理想方案,值得临床推广应用。     

胰岛素联合二甲双胍治疗2型糖尿病36例的临床研究

目的 研究胰岛素联合二甲双胍治疗2型糖尿病（T2DM）的疗效分析.方法 36例患有2型糖尿病经过磺脲类药物治疗无效的患者随机分为对照组和观察组,每组18例.对照组采用单用胰岛素治疗方案,观察组采用胰岛素联合二甲双胍治疗方案,研究并记录2组患者治疗前后的各项检查数据,对比其疗效.结果 观察组在控制血糖时间、每天胰岛素用量、空腹血糖（FBG）、餐后2h血糖（2hPBG）、糖化血红蛋白（HbA1c）、体质量指数（BMI）等各项指标均优于对照组,差异有统计学意义（P〈0.05）.结论 胰岛素联合二甲双胍在治疗2型糖尿病效果明显优于单独使用胰岛素治疗的疗效,值得临床上推广应用.     

德谷胰岛素联合二甲双胍缓释片治疗2型糖尿病患者的效果

目的 评价联合用药方法（德谷胰岛素联合二甲双胍缓释片）治疗2型糖尿病的可行性和效果,为2型糖尿病治疗工作提供参考。方法 选择我院内分泌科2018年8月至2019年10月收治治疗的2型糖尿病患者110例,结合用药治疗方案进行分组,对照组与观察组各55例。对照组患者采取二甲双胍缓释片治疗,观察组患者采取德谷胰岛素联合二甲双胍缓释片治疗。比较两组患者的治疗情况,包括临床疗效、血糖指标水平、体质量指数。结果 就临床治疗总有效率而言,观察组患者治疗总有效率更高,P <0.05。治疗后两组患者血糖指标对比,观察组空腹血糖、餐后2 h血糖、糖化血红蛋白水平控制效果更好,P <0.05。就治疗后体质量指数而言,两组指标差异无统计学意义,P> 0.05。结论 二甲双胍缓释片联合德谷胰岛素治疗2型糖尿病患者的降血糖效果更好,是治疗2型糖尿病的有效联合方案。     

两种胰岛素强化疗法治疗2型糖尿病的对比研究

目的探讨甘精胰岛素联合门冬胰岛素治疗2型糖尿病的临床疗效,为优化胰岛素强化治疗方案提供参考。方法选取127例我院收治的2型糖尿病患者,随机分为对照组(n=63)和观察组(n=64),对照组患者于三餐前30min皮下注射诺和灵R,睡前注射诺和灵N;观察组患者于三餐前即可皮下注射门冬胰岛素,睡前注射甘精胰岛素。对两组胰岛素强化疗法治疗2型糖尿病的临床疗效进行观察。结果两组患者治疗后空腹血糖及餐后2h血糖显著降低(P<0.05),但两组比较差异无统计学意义(P>0.05);但观察组血糖达标时间明显缩短,每日胰岛素用量显著减少,血糖波动及低血糖发生率明显降低。结论甘精胰岛素联合门冬胰岛素治疗2型糖尿病可较好的控制血糖,降低低血糖的发生率,是强化治疗2型糖尿病的一种理想方案。     

2型糖尿病患者启动预混胰岛素治疗病例解析

作为糖尿病血糖管理的经典药物，胰岛素一直是降糖达标的最重要选择之一。本文选取了一个口服药控制不佳的2型糖尿病患者启动预混胰岛素治疗的病例，并结合该病例针对2型糖尿病患者的胰岛素起始方案的选择及一些在胰岛素使用中的注意事项进行简要的讨论。     

甘精胰岛素联合二甲双胍片剂对2型糖尿病血糖的影响

目的观察甘精胰岛素联合二甲双胍片剂对2型糖尿病血糖的影响。方法对该院2009年3月-2012年3月期间采用甘精胰岛素联合二甲双胍片剂(观察组,n=35)和诺和灵30R(对照组,n=35)治疗的70例2型糖尿病患者的临床资料进行回顾性分析。结果观察组患者的空腹血糖(FPG)、早餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)、胰岛素用量、体重指数(BMI)和低血糖事件发生都明显改善,优于对照组,并且观察组的疗效显著地高于对照组。结论甘精胰岛素联合二甲双胍片剂能较好地控制2型糖尿患者的血糖,并且低血糖发生率低,疗效好,是治疗2型糖尿病的理想方案,值得临床推广应用。     

Vildagliptin: a novel DPP-4 inhibitor with pancreatic islet enhancement activity for treatment of patients with type 2 diabetes

Type 2 diabetes is now one of the most challenging health-care problems, and novel treatment strategies are required. The pancreatic islet dysfunction of type 2 diabetes involves problems with both insulin and glucagon since appropriate levels of both hormones are required for maintenance of glucose homeostasis. Enhancement of pancreatic function by incretins such as glucagon-like peptide (GLP)-1 is a new therapeutic approach. These incretins are inactivated by the enzyme dipeptidyl peptidase (DPP)-4. Vildagliptin is a potent, orally active, highly selective DPP-4 inhibitor that enhances the antidiabetic actions of the incretins. Pharmacokinetic studies showed that it is absorbed rapidly but has a sufficiently long period of action to require only once-daily dosing. Three phase II studies of vildagliptin use for 12 weeks in patients with type 2 diabetes have been reported. When vildagliptin was used either as monotherapy or combined with metformin, the treatment versus placebo resulted in significant reductions in hemoglobin (Hb)A(1c). The HbA(1c) was maintained during extended treatment over one year in the study of combination use with metformin. The studies indicated that the greater glycemic control appears to reflect an improvement in islet function. The improvement in glycemic control with vildagliptin was not associated with any body weight gain. Vildagliptin did not cause any clinically relevant changes in safety and was well tolerated. Therefore, further studies are being carried out on vildagliptin to assess long-term efficacy and safety in patients with type 2 diabetes.     

艾塞那肽治疗口服药失效血糖控制不佳的肥胖型2型糖尿病患者的疗效和安全性

目的观察艾塞那肽联合二甲双胍和磺脲类药物治疗口服药失效血糖控制不佳的肥胖型2型糖尿病患者的疗效和安全性。方法在用二甲双胍+磺脲类药物治疗血糖控制欠佳的肥胖型2型糖尿病患者加用艾塞那肽治疗6个月后,观察其FPG、PPG、HbA1c、低血糖发生率、体重变化情况。结果与治疗前相比,患者的FPG、PPG、HbA1c、体重变化均显著下降(P<0.05)。结论艾塞那肽可以显著改善患者的血糖,降低HbA1c,使血糖达标,同时还可以持续降低体重。     

Inhaled insulin using AERx insulin Diabetes Management System (AERx iDMS)

Diabetes is a chronic, debilitating disease that afflicts millions of people worldwide and poor glycemic control in this disease leads to numerous microvascular and macrovascular complications. There is growing evidence that tight glycemic control prevents the development, and delays the progression, of microvascular complications and possibly macrovascular disease in patients with diabetes. All patients with Type 1 diabetes and many patients with Type 2 diabetes require intensive insulin therapy to achieve optimal glucose control. Although subcutaneous insulin therapy is the mainstay of insulin therapy, there are patients who fear needles and often refuse to start insulin therapy despite suboptimal glucose control. In these patients, inhaled insulin represents a non-invasive, painless method to administer intensive insulin treatment. The Novo Nordisk AS AERx iDMS (insulin Diabetes Management System) for inhaled insulin is a novel device that administers an aerosol of liquid insulin into the deep lung with dose adjustments as precise as one subcutaneous unit. Initial pharmacokinetic and pharmacodynamic studies demonstrate that the device delivers liquid insulin in a clear dose-response manner and with a rapid onset of action similar to the fast-acting analog insulins. At present, large, long-term Phase III studies are in progress to document not only the efficacy, but also the safety and feasibility of this device in the treatment of patients with diabetes.     

Inhaled insulin using AERx® insulin Diabetes Management System (AERx® iDMS)

Diabetes is a chronic, debilitating disease that afflicts millions of people worldwide and poor glycemic control in this disease leads to numerous microvascular and macrovascular complications. There is growing evidence that tight glycemic control prevents the development, and delays the progression, of microvascular complications and possibly macrovascular disease in patients with diabetes. All patients with Type 1 diabetes and many patients with Type 2 diabetes require intensive insulin therapy to achieve optimal glucose control. Although subcutaneous insulin therapy is the mainstay of insulin therapy, there are patients who fear needles and often refuse to start insulin therapy despite suboptimal glucose control. In these patients, inhaled insulin represents a non-invasive, painless method to administer intensive insulin treatment. The Novo Nordisk AS AERx^® iDMS (insulin Diabetes Management System) for inhaled insulin is a novel device that administers an aerosol of liquid insulin into the deep lung with dose adjustments as precise as one subcutaneous unit. Initial pharmacokinetic and pharmacodynamic studies demonstrate that the device delivers liquid insulin in a clear dose–response manner and with a rapid onset of action similar to the fast-acting analog insulins. At present, large, long-term Phase III studies are in progress to document not only the efficacy, but also the safety and feasibility of this device in the treatment of patients with diabetes.     

Muraglitazar: beneficial or detrimental in the treatment of Type 2 diabetes?

Hyperglycaemia in Type 2 diabetes has a major role in the development of microvascular complications, whereas the dyslipidaemia is the major cause of macrovascular complications. In patients with Type 2 diabetes, activation of PPAR-alpha and PPAR-gamma with the fibrates and glitazones improves dyslipidaemia and increases insulin sensitivity, respectively. Muraglitazar is an agonist at both of these receptors and has been shown to increase high-density lipoprotein cholesterol, decrease triglycerides and improve insulin sensitivity. However, there is also some evidence that muraglitazar has detrimental effects on the cardiovascular system. Before muraglitazar is widely used in the treatment of Type 2 diabetes, more safety testing needs to be undertaken.     

替米沙坦联合左旋氨氯地平对原发性高血压合并2型糖尿病的疗效观察

目的 探讨替米沙坦联合左旋氨氯地平对原发性高血压合并2型糖尿病微量蛋白尿的影响.方法 将219例原发性高血压合并2型糖尿病微量蛋白尿的阳性患者随机分为替米沙坦（对照A组）,左旋氨氯地平（对照B组）,替米沙坦联合左旋氨氯地平（观察组）.每组各73例,三组治疗24w,观察3组患者治疗前后24 h动态血压、糖化血红蛋白、24 h尿微量蛋白的变化.结果 三组患者治疗24 w后,观察组总有效率98.63%,对照A组则为82.19%,对照B组80.82%.观察组较对照A、B组血压均明显下降（P＜0.05）,治疗后观察组微量蛋白尿较对照A、B两组明显下降（p＜0.05）.结论 替米沙坦联合左旋氩氯地平对原发性高血压合并2型糖尿病微量蛋白尿的患者治疗,能够较好地控制血压,明显降低微量蛋白尿,保护肾功能,值得在基层医院大力推广应用.     

罗格列酮治疗原发性高血压合并2型糖尿病疗效观察

目的：探讨罗格列酮治疗原发性高血压合并2型糖尿病的降压疗效。方法：将106例原发性高血压合并2型糖尿病患者随机分为观察组与对照组,每组53例,对照组给予降压药或注射胰岛素控制血糖,加用苯那普利10～20mg/d;观察组则在对照组的基础上加用罗格列酮15mg/d,两组12周为1个疗程,并监测血压。结果：观察组总有效率为94.34%,对照组为73.58%,两组相比差异有统计学意义（P〈0.05）。结论：罗格列酮治疗原发性高血压合并2型糖尿病安全有效,降压作用较强,有明显的肾脏保护作用。     

Inhaled human insulin ((insulin human [rDNA origin]) Inhalation Powder) in diabetes mellitus

Inhaled human insulin ((insulin human [rDNA origin]) Inhalation Powder) is a prandial insulin approved in the EU and the US for the treatment of adults with diabetes. Its glycaemic control is comparable to subcutaneous insulin in Type 1 and 2 diabetes, and has superior efficacy versus oral antidiabetic agents in Type 2 diabetes. Hypoglycaemia and mild-to-moderate cough are the main side effects. The treatment group differences in pulmonary function occur early, and are small, nonprogressive for up to 2 years and reversible following discontinuation. Patient-reported outcomes data displays higher diabetes treatment satisfaction, improvements in some quality-of-life scores, and treatment preference with inhaled human insulin versus traditional means. Availability of inhaled insulin may increase insulin acceptance and thus improve glycaemic control in patients with diabetes.     

First approved inhaled insulin therapy for diabetes mellitus

The long-term benefits of tight glycemic control in preventing microvascular and macrovascular complications are well established in both Type 1 diabetes mellitus (Type 1 DM) and Type 2 diabetes mellitus (Type 2 DM). Nonetheless, achievement of recommended haemoglobin A1c (HbA(1c)) goals (< or = 6.5 - 7.0%) has remained elusive, especially in patients with diabetes who require insulin therapy. Delayed/suboptimal titration of insulin is partly related to poor acceptance of multiple injection regimen by both physicians and patients. EXUBERA (human insulin [rDNA origin]; Pfizer), the first approved inhaled insulin for the treatment of diabetic patients, has been shown to be safe and as effective as regular/rapidly acting insulin in improving glycemic control. In addition to controlling postprandial glucose excursions, EXUBERA exerts a major action to reduce fasting plasma glucose (FPG) concentration. Thus, it has the potential to be used as a monotherapy in Type 2 DM, as well as in combination with an insulin sensitizer in Type 2 DM or in combination with long-acting insulin in both Type 2 DM and Type 1 DM.     

Inhaled human insulin (Exubera®): its pharmacologic profile,efficacy and safety in the treatment of adults with diabetes mellitus

Exubera^® (EXU, insulin human [rDNA origin]) is the first inhaled insulin approved for the treatment of diabetes in adults. Its pharmacokinetic properties make it suitable as therapy for postprandial glycemia. Clinical trials have demonstrated equal efficacy with short-acting subcutaneous regular and analog insulin in both Type 1 and 2 diabetes, and have also shown that it has value as adjunctive therapy in Type 2 patients inadequately controlled on maximal doses of oral hypoglycemic agents. EXU is well tolerated and associated with a high level of patient satisfaction. Hypoglycemia is the most common adverse event but its incidence does not exceed that expected for the degree of glycemic improvement. Minor reductions in some measures of pulmonary function have been observed in EXU-treated patients but safety studies of up to 2 years duration reveal that they occur early, do not progress and resolve quickly after treatment cessation. Longer-term postregistration pulmonary function studies that include assessment of insulin antibodies and the associated risk of allergic/immune disorders are in progress. EXU overcomes problems associated with the invasive nature of subcutaneous injection without loss of efficacy. Depending on cost and confirmation of safety, it could be a valuable part of future treatment strategies for both Type 1 and 2 diabetes.