甘精胰岛素联合口服降糖药治疗T2DM

26例应用口服降糖药血糖控制不理想的T2DM患者随机分为甘精胰岛素组（n=13）和预混胰岛素组（n=13）。原口服药不变，每晚10点注射甘精胰岛素。预混胰岛素组采用早、晚餐前30min皮下注射胰岛素，停服原有口服降糖药，若餐后血糖高，加用阿卡波糖片用量（150mg／d）。两组治疗目标为空腹血糖≤6．8mmol／L和餐后2h血糖≤10．0mmol／L。结果治疗后两组血糖均良好下降，但甘精组低血糖事件明显少于预混组。结论甘精胰岛素联合口服降糖药物可以良好地控制高血糖，且低血糖发生率低。     

甘精胰岛素联合口服降糖药治疗T2DM

26例应用口服降糖药血糖控制不理想的T2DM患者随机分为甘精胰岛素组(n=13)和预混胰岛素组(n=13).原口服药不变,每晚10点注射甘精胰岛素.预混胰岛素组采用早、晚餐前30min皮下注射胰岛素,停服原有口服降糖药,若餐后血糖高,加用阿卡波糖片用量(150mg/d).两组治疗目标为空腹血糖≤6.8mmol/L和餐后2h血糖≤10.0mmol/L.结果 治疗后两组血糖均良好下降,但甘精组低血糖事件明显少于预混组.结论 甘精胰岛素联合口服降糖药物可以良好地控制高血糖,且低血糖发生率低.     

甘精胰岛素联合口服降糖药治疗老年2型糖尿病疗效观察

目的探讨分析研究甘精胰岛素联合口服降糖药针对治疗老年2型糖尿病的治疗效果。方法选取2010年10月—2012年12月的80例老年2型糖尿病患者资料进行回顾性分析,将80例患者随机分为两组,观察组和对照组各40例,观察组患者使用甘精胰岛素联合口服降糖药加以治疗,对照组患者使用预混胰岛素加以治疗,比较观察组和对照组患者的治疗效果,将两组患者空腹血糖和餐后2 h时血糖水平加以统计分析。结果观察组患者的治疗总有效率为96.8%,对照组为69.7%,两组比较有显著差异有统计学意义（P〈0.05）;两组患者的临床各项指标全部获得改善,观察组患者的改善情况显著优于对照组患者,差异有统计学意义（P〈0.05）。结论针对老年2型糖尿病患者实施甘精胰岛素联合口服降糖药的治疗效果显著,能够显著改善患者的血糖水平,增强患者的生活质量,应该在临床中加以推广使用。     

利拉鲁肽联合甘精胰岛素与基础-餐时胰岛素强化治疗对新诊断2型糖尿病的疗效及安全性比较

目的比较利拉鲁肽联合甘精胰岛素与基础-餐时胰岛素强化治疗对新诊断2型糖尿病的疗效及安全性。方法采用前瞻性设计,选取2019年1月至2020年6月在福建医科大学附属泉州第一医院内分泌科住院的新诊断2型糖尿病患者150例,根据随机数字表法将纳入患者按1∶1随机分为利拉鲁肽联合甘精胰岛素组(试验组,75例)及基础-餐时胰岛素组(对照组,75例)。基础-餐时胰岛素组三餐前注射门冬胰岛素,睡前注射甘精胰岛素,给予强化治疗4周。主要研究终点为血糖达标时间,次要终点为第4周时体重较基线改变、稳态模型评估胰岛素抵抗指数(HOMA-IR)变化及低血糖情况。分别采用t检验、配对t检验、协方差分析及χ2检验进行统计分析。结果试验组和对照组分别有72和73例。试验组共有3例(4.0%)发生4次低血糖,对照组有10例(13.3%)发生14次低血糖,差异具有统计学意义(χ²=4.227,P=0.040)。经强化治疗4周后,试验组血糖达标时间为(6.0±1.8)d,对照组为(5.6±1.7)d,差异无统计学意义(t=1.396,P=0.165)。第4周结束时,试验组体重较基线下降(1.61±0.73)kg,差异有统计学意义(t=2.224,P=0.029),对照组体重较基线上升(1.15±0.81)kg,差异无统计学意义(t=1.413,P=0.162)。试验组HOMA-IR较基线下降6.24±0.34,对照组HOMA-IR较基线下降5.80±0.29,差异均有统计学意义(t=18.642、19.853,均P<0.01)。采用协方差分析发现,利拉鲁肽联合甘精胰岛素可以较基础-餐时胰岛素方案进一步改善HOMA-IR(F=2.620,P=0.027)。结论利拉鲁肽联合甘精胰岛素不仅对新诊断2型糖尿病的疗效不劣于基础-餐时胰岛素强化治疗方案,且还具有减轻体重、减少低血糖风险以及改善胰岛素抵抗的优势。     

口服降糖药联合甘精胰岛素治疗2型糖尿病的疗效观察

对40例单用口服降糖药物效果欠佳的T2DM患者联合甘精胰岛素治疗,分别于治疗前及治疗后（3个月）观察空腹血糖（FPG）、餐后2h血糖（2hPG）、体重指数的变化。结果联合甘精胰岛素治疗后FPG、2hPG、HbA1c较治疗前明显下降（P〈0.05）,而体重指数影响不大,且无明显低血糖反应。结论口服降糖药物联合甘精胰岛素治疗具有作用佳、安全性好的特点。     

甘精胰岛素联合口服降糖药和诺和锐30治疗2型糖尿病的比较

60例口服降糖药血糖控制不良的T2DM患者随机分为甘精组,n=30和预混组,n=30,所有患者以二甲双胍作为基础用药,后血糖控制不良者酌情加用瑞格列奈;预混组每日餐前分别注射2～3次诺和锐30。根据血糖水平调整胰岛素剂量,观察12周。结果:两组治疗后血糖及HbA1c较前明显下降、C肽分泌改善(P0.01),甘精组空腹血糖下降更明显(P0.05)、空腹血糖达标时间缩短、低血糖发生率低、胰岛素用量明显减少(P0.01)并且体重无明显改变(P0.05)。结论:以二甲双胍为基础治疗措施的T2DM患者联合甘精胰岛素、瑞格列奈治疗可以有效降低血糖,空腹血糖控制更低、更快,对体重影响小,低血糖发生率低。     

甘精胰岛素联合口服降糖药治疗肥胖2型糖尿病患者的疗效观察

目的 观察甘精胰岛素联合阿卡波糖和(或)二甲双胍治疗肥胖T2DM临床疗效.方法 32例肥胖T2DM患者,在注射预混Ins一段时间后血糖控制不理想情况下,改用甘精胰岛素联合阿卡波糖和(或)二甲双胍,疗程3个月,观察治疗前后BP、FPG、HbA_1c、TC、TG、HDL-C、LDL-C、UA、C-P、UAER变化情况,计算HOMA-IR、HOMA-β.结果 治疗后BMI、FPG、HOMA-IR低于治疗前,而C-P、HOMA-β高于治疗前(P＜0.05).结论 甘精胰岛素联合阿卡波糖和(或)二甲双胍治疗肥胖T2DM,不仅成功控制血糖,且明显改善IR,治疗中无明显体重增加等不良反应.     

甘精胰岛素联合口服降糖药治疗老年2型糖尿病的作用价值

目的:探究对老年2型糖尿病患者实行甘精胰岛素联合口服降糖药治疗方式的临床价值.方法:选取我院2020年11月-2021年11月收治的200例老年2型糖尿病患者作为研究对象,按照Spread软件分组方法分为单一组(100例)与联合组(100例),单一组采用口服降糖药单一治疗方法,联合组在单一组用药基础上采用联合甘精胰岛素...     

甘精胰岛素联合口服降糖药治疗2型糖尿病临床观察及剂量探讨

129例T2DM住院患者,使用甘精胰岛素联合口服降糖药治疗。结果治疗后空腹血糖和餐后2小时血糖均显著下降;两两相关检验的显示,甘精胰岛素每日剂量与年龄、体重、身高、糖化血红蛋白、空腹血糖、餐后2小时血糖之间有显著相关性;经回归方程分析,回归系数P值小于0.05的有体重和空腹血糖,甘精胰岛素每日剂量与体重、空腹血糖之间有线性关系。低血糖发生率低。结论使用甘精胰岛素联合口服降糖药治疗2型糖尿病T2DM患者可良好控制血糖。     

一针一药一家欢（下）——论基础胰岛素与口服降糖药的联合应用

前面我们说过，基础胰岛素牵手不同机制的口服降糖药，能简单方便有效地控制基础和餐时血糖。下面我们具体分析一下。     

Introducing a simplified approach to insulin therapy in type 2 diabetes: a comparison of two single‐dose regimens of insulin glulisine plus insulin glargine and oral antidiabetic drugs

Aim: To investigate whether the addition of a single bolus of insulin glulisine (glulisine), administered at either breakfast or main mealtime, in combination with basal insulin glargine (glargine) and oral antidiabetic drugs (OADs), provides equivalent glycaemic control in patients with type 2 diabetes, irrespective of the time of glulisine injection. Methods: A national, multicentre, randomized, open‐label, parallel‐group study of 393 patients with type 2 diabetes who were suboptimally controlled [haemoglobin A_1c (HbA_1c) > 6.5–9.0% and fasting blood glucose (BG) ≤6.7 mmol/l] on their previous glargine and OAD regimen. A single injection of glulisine was added, either at breakfast or at main mealtime, to their existing therapy. Results: The per‐protocol group (n = 316) showed improved HbA_1c (baseline vs. end‐point) in the breakfast (7.4 vs. 7.0%; p < 0.0001) and main mealtime groups (7.3 vs. 6.9%; p < 0.0001). Glulisine given at breakfast was equally effective in controlling HbA_1c as glulisine given at the main mealtime [adjusted HbA_1c mean difference (95% confidence interval): 0.0481% (–0.115 to 0.211); p < 0.0001 for equivalence]. Overall, 30.7% of patients achieved HbA_1c≤6.5% at end‐point but slightly more patients met this target in the main mealtime group vs. the breakfast group (33.8 vs. 27.8%; p = NS). This trend continued and was more marked when considering only those patients with HbA_1c >7.0% at baseline and who reached HbA_1c≤7.0% at end‐point (44.1% overall), with 52.2 and 36.5% for main mealtime and breakfast groups, respectively (p = 0.028). Most postprandial BG values improved within each group, while the number of hypoglycaemias was low and comparable between the two treatment groups. Conclusions: A single bolus of glulisine, added to glargine and OADs, resulted in significantly improved HbA_1c levels, irrespective of whether glulisine was administered at breakfast or at main mealtime. These results may represent a simplified and effective approach to treatment intensification in type 2 diabetes patients.     

预混胰岛素治疗的2型糖尿病患者转为甘精胰岛素联合口服药治疗的疗效分析

目评价甘精胰岛素联合口服降糖药物(OADs)治疗方案对使用预混胰岛素血糖控制欠佳的2型糖尿病患者的疗效及安全性.方法 预混胰岛素30/70单独或联合使用OADs血糖控制不良的2型糖尿病患者50例,随机分为治疗组(停用预混胰岛素,改为皮下注射甘精胰岛素联合OADs,n=30)和对照组(继续使用预混胰岛素早、晚餐前皮下注射...     

甘精胰岛素联合口服降糖药物对血糖控制不佳的2型糖尿病患者的疗效观察

目的 评价甘精胰岛素(来得时(R))与盐酸吡格列酮和二甲双胍联合应用治疗口服降糖药物控制不佳的2型糖尿病患者的有效性和安全性.方法 采用随机法将78例口服降糖药物控制不佳的2型糖尿病患者分为A、B两组.A组为甘精胰岛素(来得时(R))组,B组为精蛋白锌胰岛素(诺和灵N)组,两组均口服吡格列酮和二甲双胍,观察治疗后空腹血...     

2周胰岛素强化治疗对口服药失效的2型糖尿病患者外周血核因子кB的影响

目的 比较胰岛素强化治疗前后口服抗糖尿病药失效2型糖尿病(T2DM)患者外周血单核细胞中核因子кB(NF-кB)表达水平的变化,探讨胰岛素的抗炎作用. 方法 选择对照组20名(NC组),口服药失效的T2DM患者20例(DM组)给予胰岛素强化治疗2周.检测DM组治疗前后空腹血精(FBG)、空腹胰岛素(FIns)和C肽以及餐后2hBG、胰岛素和C肽水平的变化及采用流式细胞仪(FCM)、竞争性酶联免疫吸附法(ELISA)检测治疗前后外周血单核细胞NF-кB表达水平的变化. 结果与NC组比较,T2DM患者外周血单核细胞NF-кB表达升高(P<0.01);与治疗前比较,胰岛素强化治疗2周后,NF-кB表达降低(P<0.01);FBG、2hBG和HOMA-IR降低;胰岛素、C肽和HOMA-β升高. 结论 T2DM患者2周胰岛素强化治疗后,血糖明显改善的同时,单核细胞中NF-кB表达明显降低.     

Combination of oral antidiabetic agents with basal insulin versus premixed insulin alone in randomized elderly patients with type 2 diabetes mellitus

OBJECTIVES: To compare initiation of insulin therapy by adding once-daily insulin glargine to oral antidiabetic agents (OADs) with switching patients to premixed 30% regular, 70% human neutral protamine hagedorn insulin (70/30) without OADs. DESIGN: A 24-week, multicenter, open, randomized (1:1), parallel study. SETTING: Three hundred sixty-four poorly controlled patients with type 2 diabetes mellitus were treated with once-daily morning insulin glargine with continued OADs (glimepiride+metformin) (glargine+OAD) or twice-daily 70/30 alone. Insulin dosage in each group was titrated to target fasting blood glucose (FBG) of 100 mg/dL or less (or=6.7 mmol/L) and hemoglobin (Hb)A(1c) levels between 7.5% and 10.5% on OADs (glargine+OAD, n=67; 70/30, n=63). MEASUREMENTS: HbA(1c), FBG, hypoglycemia, insulin dose, and adverse events were recorded. RESULTS: HbA(1c) decreased from baseline to endpoint for both glargine+OAD (from 8.8% to 7.0%) and 70/30 (from 8.9% to 7.4%); adjusted mean HbA(1c) decrease for glargine+OAD and 70/30 was -1.9% and -1.4%, respectively (P=.003). More patients reached HbA(1c) of 7.0% or less without confirmed nocturnal hypoglycemia with glargine+OAD (n=37, 55.2%) than with 70/30 (n=19, 30.2%) (P=.006). FBG decreased significantly more with glargine+OAD (-57 mg/dL (-3.2 mmol/L)) than with 70/30 (-40 mg/dL (-2.2 mmol/L)) (P=.002). Patients treated with glargine+OAD experienced fewer episodes of any hypoglycemia (3.68/patient-year) than did those treated with 70/30 (9.09/patient-year) (P=.008). CONCLUSION: In elderly patients, addition of once-daily morning glargine+OAD is a simple regimen to initiate insulin therapy, restoring glycemic control more effectively and with less hypoglycemia than twice-daily 70/30 alone.     

甘精胰岛素治疗2型糖尿病有效性及安全性的多中心临床研究

目的 观察对于尚未使用胰岛素治疗血糖控制不佳的2型糖尿病患者,启动甘精胰岛素治疗的有效性、安全性和可行性.方法 为多中心、开放性、自身对照的临床观察性研究,共22个研究中心565例2型糖尿病患者参与.患者在0～3种口服降糖药治疗的基础上联合应用甘精胰岛素治疗12周后,评价甘精胰岛素治疗的有效性和安全性.结果 受试者平均糖化血红蛋白(Hb)Alc由基线时的8.0%±0.99%下降至6.3%±0.64%(P＜0.01).以HbAlC＜6.5%以及＜7.0%为目标值,达标率分别为66.55%和87.61%.患者全天7点血糖包括3餐前血糖、3餐后血糖及睡前血糖均得到明显改善.治疗期间有92例(16.3%)受试者发生低血糖事件129次,均为一般性低血糖,发生率为0.91次/(患者·年).体重及体重指数均有所下降;无肝、肾功能损伤,其他不良反应轻微.结论 对于经单纯生活方式干预或口服降糖药治疗血糖控制不佳的2型糖尿病患者,早期启动甘精胰岛素作为胰岛素的起始治疗用药,可使大多数患者安全、有效地达标.     

Safety and efficacy of insulin glargine (HOE 901) versus NPH insulin in combination with oral treatment in Type 2 diabetic patients

Aims A European, randomized, 29‐centre, open‐label study compared the safety and efficacy of two formulations of insulin glargine and neutral protamine Hagedorn (NPH) human insulin, in combination with oral agents, in patients with Type 2 diabetes mellitus (DM). Methods Two‐hundred‐and‐four patients with Type 2 DM, in whom oral treatment alone was inadequate, were randomized to insulin glargine with 30 µg/ml zinc [insulin glargine (30)], or insulin glargine with 80 µg/ml zinc [insulin glargine (80)] or NPH insulin subcutaneously once daily. Insulin was titrated to aim for fasting blood glucose (FBG) values between 4 and 7 mmol/l. All participants received oral therapy during the 3‐week titration phase and 1‐week maintenance phase of the trial. Results No differences between treatment groups were observed in adjusted mean fasting plasma glucose; significant decreases of 3.4 mmol/l, 3.5 mmol/l and 3.1 mmol/l were observed within the insulin glargine (30), insulin glargine (80) and NPH insulin groups, respectively (P < 0.0001 in each case). No differences between groups, but significant changes within groups, were observed in self‐monitored FBG, mean FBG, blood glucose profile, stability of FBG, nocturnal blood glucose, fasting serum C‐peptide, non‐esterified fatty acids, haemoglobin A_1c, fructosamine and fasting serum insulin. A significantly greater proportion of NPH insulin patients experienced symptomatic nocturnal hypoglycaemia (19.1 NPH group vs. 7.3% glargine groups; P = 0.0123). Both insulins were well tolerated; one patient in each group experienced an injection site reaction. Conclusions Insulin glargine is as safe and effective as NPH insulin given once daily and in this study caused fewer episodes of nocturnal hypoglycaemia. Diabet. Med. 20, 545–551 (2003)     

格列美脲联合胰岛素治疗2型糖尿病的多中心临床研究

目的研究在接受胰岛素治疗的2型糖尿病患者中,联合应用格列美脲治疗的疗效及对胰岛素使用剂量的影响.方法为多中心、开放、自身对照的临床研究.100例胰岛素治疗剂量≥50 U/d(胰岛素单用或与≤2种非胰岛素促泌剂联合应用)的2型糖尿病患者,加用格列美脲治疗12周.结果 12周后,糖化血红蛋白(Hh)A1c由基线时的(8.89±1.77)%降至(7.02±0.86)%,下降了(1.86±1.43)%.以HbA1c≤6.5%和<7.0%为目标值,达标率分别为34%和59%,达标率增加31%和50%.胰岛素的剂量由基线时的66.0 U/d降至50.0 U/d,剂量减少26.67%.患者的全天血糖谱均明显改善.治疗期间,30例患者(30%)发生一般性低血糖68件·次,低血糖发生率为2.95次/(患者·年),无严重低血糖事件.受试者体重及体重指数均无明显变化.结论在胰岛素治疗的基础上联合应用格列美脲可有效降低2型糖尿病患者空腹血糖、餐后血糖水平,有利于患者实现HbA1c达标;同时可显著降低胰岛素用量,提高治疗的安伞性和耐受性.     

Factors associated with basal insulin dose in Japanese children and young adult type 1 diabetics

Aims/Introduction: The daily basal insulin doses/body weight and the daily basal insulin doses/total daily insulin doses of Japanese type 1 diabetes mellitus patients are less than those of Western type 1 diabetes mellitus patients. It is known that Western meals are richer in fat than Japanese meals. We speculated that fat intake might be associated with basal insulin dose in type 1 diabetes mellitus patients. Materials and Methods: Forty‐one outpatients with type 1 diabetes mellitus (20 males, 21 females, mean age 15.9) were enrolled. Variables investigated included: gender, SDS‐BMI, HbA1c, duration of diabetes, therapy (MDI or CSII), insulin doses and meal contents. Meal contents were recorded for 3 days using a digital camera. Correlation and multiple regression analyses were performed for all subjects and each age group. Results: The mean daily basal insulin doses/total daily insulin doses was 0.35. In the multiple regression analysis among all subjects, when daily basal insulin doses/body weight was used as a dependent variable, fat energy ratio of the meal was obtained as an entered variable (P = 0.001). This tendency was particularly strong among the patients aged 14 or above (P < 0.001, standardized coefficient β = 0.683). Conclusions: In the type 1 diabetes patients who are aged 14 or above, an association between daily basal insulin doses/body weight and fat energy ratio of meal was suggested. This may explain the aforementioned expectation of increased fat intakes making higher basal insulin doses. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00171.x, 2011)