伏格列波糖联合胰岛素治疗肥胖型2型糖尿病的疗效分析

目的探讨伏格列波糖联合胰岛素治疗肥胖型2型糖尿病的临床效果。方法入选的32例肥胖型2型糖尿病患者均为在我院就诊治疗的病例,随机分为观察组和对照组。两组患者均给予饮食指导和运动指导,观察组和对照组患者均给予精蛋白生物合成胰岛素30 R,每天两次进行皮下注射,根据测定患者血糖水平对所用剂量进行调整。观察组患者同时给予伏格列波糖治疗,每次0.2 mg,每天服用3次,连续应用8周。测定两组患者治疗前后血糖指标。结果观察组治疗后的FPG、2h PG、Hb A1c分别和本组治疗前的FPG、2h PG、Hb A1c水平比较,差异有统计学意义(P<0.05);对照组治疗后的FPG、2h PG、Hb A1c分别和本组治疗前的FPG、2h PG、Hb A1c水平比较,差异有统计学意义(P<0.05);观察组治疗后的FPG、2h PG、Hb A1c分别和对照组治疗后的FPG、2h PG、Hb A1c比较,差异有统计学意义(P<0.05)。两组均未出现严重不良反应而影响疗程,均顺利完成疗程。结论伏格列波糖联合胰岛素治疗肥胖型2型糖尿病疗效显著,能够更好的控制血糖水平,值得借鉴。     

地特胰岛素与甘精胰岛素治疗血糖控制不佳2型糖尿病的临床对照研究

目的探讨地特胰岛素与甘精胰岛素治疗血糖控制不佳2型糖尿病的临床效果。方法选取我院2014年6月至2016年6月收治的60例血糖控制不佳的2型糖尿病患者,依据不同胰岛素而将其分为地特胰岛素组和甘精胰岛素组,各30例,对比两种胰岛素血糖控制效果。结果两组患者基础胰岛素用量、胰岛素用量及血糖达标时间对比无明显差异(P>0.05);两组患者治疗前FPG、2h PG及Hb A1c比较无明显差异(P>0.05),经相关胰岛素治疗,指标均明显下降(P<0.05),但组间对比无统计学差异(P>0.05)。结论地特胰岛素与甘精胰岛素治疗血糖控制不佳的2型糖尿病效果无差异,故临床可根据患者的自身情况,合理选择治疗药物。     

地特胰岛素联合瑞格列奈治疗2型糖尿病的临床对照研究

目的 探讨地特胰岛素联合瑞格列奈治疗2型糖尿病的临床疗效及安全性。方法 选取2013年1月2014年2月玉溪市人民医院收治的口服2种以上降糖药物血糖控制不佳的2型糖尿病患者85例,随机分为试验组(n=41)和对照组(n=44)。试验组给予地特胰岛素初始剂量0.1 U·kg-1,每晚22∶00皮下注射,瑞格列奈0.5~1.0 mg,三餐前15 min口服;对照组在早、晚餐前10 min皮下注射门冬胰岛素30,0.5~1.0 U·kg-1;2组患者治疗周期为3个月。观察患者治疗期间空腹血糖(FPG)、餐后2 h血糖(2 h PG)和糖化血红蛋白(Hb A1C)等指标变化情况。结果 治疗后2组患者FPG、2 h PG及Hb A1C与治疗前比较均显著降低(P<0.05),但试验组患者治疗期间血糖波动较小。治疗后2组患者空腹C肽及餐后2 h C肽均明显下降(P<0.05),且试验组下降水平更为显著(P<0.05)。治疗期间,试验组发生低血糖1例,对照组8例,对照组显著高于试验组(P<0.05)。结论 地特胰岛素联合瑞格列奈治疗2型糖尿病可平稳降低血糖水平,降低低血糖的发生率。     

甘精胰岛素与阿卡波糖片联合治疗老年糖尿病的临床观察

目的探讨甘精胰岛素与阿卡波糖片联合治疗老年糖尿病的临床效果。方法入选的50例老年2型糖尿病患者均为虹山片区干休所诊疗的病例,随机分为观察组和对照组。两组患者均给予饮食指导和运动指导,观察组和对照组患者均给予阿卡波糖,根据测定患者血糖水平对所用剂量进行调整。观察组患者同时给予甘精胰岛素。两组均连续应用12周。测定两组患者治疗前后血糖指标。结果观察组治疗后的FPG、2h PG、Hb A1c分别和本组治疗前的FPG、2h PG、Hb A1c水平比较,差异有统计学意义(P<0.05);对照组治疗后的FPG、2h PG、Hb A1c分别和本组治疗前的FPG、2h PG、Hb A1c水平比较,差异有统计学意义(P<0.05);观察组治疗后的FPG、2 h PG、Hb A1c分别和对照组治疗后的FPG、2h PG、Hb A1c比较,差异有统计学意义(P<0.05)。观察组发生低血糖4例,发生率为16.0%;对照组发生低血糖3例,发生率为12.0%,观察组和对照组低血糖发生率比较,差异无统计学意义(P>0.05)。结论甘精胰岛素与阿卡波糖片联合治疗老年糖尿病疗效显著,能够更好的控制血糖水平,值得借鉴。     

地特胰岛素联合二甲双胍治疗新诊断2型糖尿病的效果观察

目的：探讨地特胰岛素联合二甲双胍治疗新诊断2型糖尿病的效果和安全性。方法选取2013年11月~2014年10月在本科就诊的32例新诊断2型糖尿病患者,给予地特胰岛素晚10时皮下注射,同时口服盐酸二甲双胍肠溶片,治疗12周后观察空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、体质指数(BMI)的变化及低血糖发生率。结果治疗12周后,FPG、2 h PG及HbA1c均较治疗前明显降低(P<0.05),78.1%的患者FPG降至<7.0 mmol/L。BMI较治疗前稍有降低,但差异无统计学意义(P>0.05)。所有患者在治疗过程中未出现明显不良反应。结论地特胰岛素联合二甲双胍治疗新诊断2型糖尿病能有效控制血糖,安全性高,值得临床推广应用。     

门冬胰岛素联合地特胰岛素对妊娠期糖尿病患者血糖控制效果及母婴结局的影响

目的：探讨门冬胰岛素联合地特胰岛素对妊娠期糖尿病(GDM)患者血糖控制效果及母婴结局的影响。方法：选择2019年8月至2021年7月于赣州市妇幼保健院治疗的86例GDM患者,按随机数字表法将其分为两组,各43例。对照组采用门冬胰岛素治疗,观察组采用门冬胰岛素、地特胰岛素治疗。比较两组空腹血糖(FPG)、餐后2 h血糖(2 h PG)达标时间、血糖控制效果及母婴结局。结果：治疗后,观察组FPG达标时间(7.11±1.97)d、2 h PG达标时间(6.38±1.45)d短于对照组;观察组FPG(5.59±1.02)mmol/L、2 h PG(6.68±0.94)mmol/L及糖化血红蛋白(HbA1c)(5.97±1.22)%低于对照组,差异有统计学意义(P<0.05);两组剖宫产率、早产率及新生儿低血糖、新生儿低体重、巨大儿发生率比较,差异无统计学意义(P>0.05)。结论：GDM患者采用门冬胰岛素、地特胰岛素联合治疗是安全可行的,可降低血糖水平,提高血糖控制效果,缩短FPG、2 h PG达标时间,且对母婴结局影响小。     

地特胰岛素联合瑞格列奈治疗初诊2型糖尿病的疗效及安全性观察

目的观察地特胰岛素联合瑞格列奈治疗初诊2型糖尿病患者的疗效及安全性。方法选择初次诊断2型糖尿病患者48例,给予地特胰岛素联合瑞格列奈口服治疗12周,比较治疗前后FPG、2h PG、HbA1c、胰岛素抵抗指数(HOMA-IR)以及胰岛β细胞功能指数(HOMA-β)、血脂、体质量情况及低血糖发作情况。结果 1治疗后,FPG、2hPG、HbA1c、HOMA-IR显著下降,HOMA-β显著升高(P<0.05)。2治疗后TC、TG、LDL-Ch与治疗前相比差异具有显著性,P<0.05。治疗前后HDL-Ch、体质量差异无统计学意义(P>0.05)。3治疗期间有2例低血糖发生,无夜间低血糖及严重低血糖事件发生。结论初发2型糖尿病患者应用地特胰岛素联合瑞格列奈治疗方案可有效控制血糖,降低低血糖风险,减少体质量增加。     

格列美脲联合地特胰岛素治疗2型糖尿病疗效及安全性分析

目的探讨格列美脲联合地特胰岛素治疗2型糖尿病疗效及安全性。方法选取2012年4月~2014年4月我院收治220例2型糖尿病患者,随机分为实验组与对照组,每组各110例。对照组患者予以格列美脲联合中性精蛋白锌人胰岛素进行治疗,实验组患者予以格列美脲联合地特胰岛素进行治疗,为期半年。治疗结束后,对两组患者的Hb A1C、FBG、2h PG、0min C肽以及120min C肽进行测定、记录,另外对两组患者胰岛素的用量、血糖达标所需时间、体重增加值以及不良反应的发生情况进行统计记录。结果用药前,实验组患者与对照组患者Hb A1C、FBG、2h PG比较差异无统计学意义(P0.05);用药后,两组患者的血糖水平均有所下降,以实验组下降更为显著,差异有统计学意义(P0.05);与对照组比较,实验组胰岛素用量低,血糖达标时间短,体重增加少,差异有统计学意义;实验组不良反应发生率较对照组低,为显著性差异(P0.05)。结论格列美脲联合地特胰岛素治疗2型糖尿病,可快速有效的控制血糖,不良反应发生率低,安全性高,适宜于临床推广应用。     

止渴养阴胶囊联合门冬胰岛素治疗2型糖尿病的临床研究

目的研究止渴养阴胶囊联合门冬胰岛素治疗2型糖尿病的临床疗效和安全性。方法选取2013年2月—2015年10月于延安市人民医院就诊的2型糖尿病患者86例,随机分成对照组和治疗组,每组各43例。对照组皮下注射门冬胰岛素注射液,起始剂量0.6 U/kg,每隔1~2天根据空腹血糖(FPG)和餐后2 h血糖(2 h PG)水平调整剂量。治疗组在对照组的基础上口服止渴养阴胶囊,3粒/次,3次/d。两组患者均连续治疗3个月。观察两组的临床疗效,同时比较两组治疗前后的FPG、2 h PG、Hb Alc、空腹C肽、2 h C肽水平、血糖达标时间、日血糖波动情况、日胰岛素用量以及低血糖发生率。结果治疗后,对照组和治疗组的总有效率分别为81.40%、95.35%,两组比较差异有统计学意义(P0.05)。治疗后FPG、2 h PG、Hb Alc水平下降,空腹C肽水平升高,同组治疗前后差异具有统计学意义(P0.05);且治疗组FPG、2 h PG、Hb Alc和空腹C肽水平改善程度优于对照组,差异具有统计学意义(P0.05)。治疗后治疗组血糖达标时间明显缩短,日胰岛素用量减少,低血糖发生率降低,两组比较差异有统计学意义(P0.05)。结论止渴养阴胶囊联合门冬胰岛素能够显著的提高2型糖尿病的治疗效果,减少日胰岛素用量少,降低低血糖发生率。     

地特胰岛素联合瑞格列奈治疗2型糖尿病疗效观察

目的 观察地特胰岛素联合瑞格列奈治疗2型糖尿病的临床疗效.方法 对40例口服降糖血糖控制不理想的2型糖尿病患者给予地特胰岛素联合瑞格列奈,治疗12周观察血糖改变和临床疗效.结果 治疗12周后患者的空腹血糖(FBG)、餐后2 h血糖(2 hPBG)及糖化血红蛋白(HbAIC)水平较治疗前明显降低,差别有统计学意义(P<0.05),体重指数(BMI)与治疗前比较差别无统计学意义(P>0.05).结论 地特胰岛素联合瑞格列奈治疗2型糖尿病可有效控制其血糖和体重,患者依从性好,不良反应少.     

Human insulin genome sequence map,biochemical structure of insulin for recombinant DNA insulin

Insulin is a essential molecule for type I diabetes that is marketed by very few companies. It is the first molecule, which was made by recombinant technology; but the commercialization process is very difficult. Knowledge about biochemical structure of insulin and human insulin genome sequence map is pivotal to large scale manufacturing of recombinant DNA Insulin. This paper reviews human insulin genome sequence map, the amino acid sequence of porcine insulin, crystal structure of porcine insulin, insulin monomer, aggregation surfaces of insulin, conformational variation in the insulin monomer, insulin X-ray structures for recombinant DNA technology in the synthesis of human insulin in Escherichia coli.     

Intentional overdose with insulin glargine and insulin aspart

Reports of intentional massive overdoses of insulin are infrequent. A review of the literature revealed no reports of overdose attempts with either insulin glargine or insulin aspart. We report the case of a 33-year-old woman without diabetes mellitus who intentionally injected herself with an overdose of both products, which belonged to her husband. She arrived at the emergency department 15 hours after her suicide attempt, which took place the night before. Her husband had checked her blood glucose level throughout the night and had given her high-carbohydrate drinks and foods. The patient had a history of obsessive-compulsive disorder, major depression, and numerous suicide attempts. She recovered from the resulting hypoglycemia after 40 hours of dextrose infusion and was transferred to a mental health facility. The main danger associated with insulin overdose is the resultant hypoglycemia and its effects on the central nervous system; hypokalemia, hypophosphatemia, and hypomagnesemia also can develop with excess insulin administration. Dextrose infusion, with liberal oral intake when possible, and monitoring for electrolyte changes, making adjustments as needed, are recommended for the treatment of intentional insulin overdose.     

赖脯胰岛素联合甘精胰岛素在模拟胰岛素泵强化治疗糖尿病中的效果

目的比较赖脯胰岛素联合甘精胰岛素与胰岛素泵在2型糖尿病强化治疗中的疗效和安全性。方法将2型糖尿病病人随机分成两组,A组的病人采用三餐前赖脯胰岛素联合甘精胰岛素治疗,B组的病人采用胰岛素泵（使用赖脯胰岛素）降糖治疗。监测两组病人治疗前后全天血糖谱的变化,观察并比较血糖达标所需要的时间、胰岛素用量、低血糖发生率等情况。结果A组与B组相比,在血糖达标所需的时间、胰岛素用量及低血糖发生率等方面没有显著性差异（P〉0.05）。结论赖脯胰岛素联合甘精胰岛素治疗2型糖尿病患者,在疗效、安全性方面接近胰岛素泵,在治疗费用方面则具有一定的优势。     

胰岛素泵诺和锐治疗2型糖尿病胰岛素抵抗的临床观察

目的:比较基因重组人胰岛素与人胰岛素类似物以胰岛素泵为输入载体时对于2型糖尿病胰岛素抵抗的疗效.方法:34例2型糖尿病胰岛素抵抗的患者随机分为两组:诺和锐治疗组及诺和灵对照组各17例,均为使用胰岛素强化治疗血糖控制不佳的胰岛素抵抗患者.根据毛细血糖监测结果调整胰岛素用量,比较两组血糖达标后每日药量及达标所需时间.结果:治疗组达标后每日药量及达标所需时间均显著少于对照组.结论:胰岛素泵诺和锐治疗2型糖尿病胰岛素抵抗的疗效明显优于胰岛素泵诺和灵.     

Inhaled insulin

Inhalation of regular insulin for meal time glucose control has been found to be safe, efficacious and reliable in Type I and Type II diabetics. The administration of regular insulin through the human lungs by inhalation has been conducted in at least 14 short studies in both normal and diabetic subjects beginning as early as 1925. In all studies, significant insulin absorption and lowering of blood glucose was observed in the absence of penetration enhancers. Although a concern of variable dosing was raised in early studies, the development of new reproducible delivery systems has ensured that the variability of aerosol insulin can be as good, if not better, than subcutaneous (SC) injection. In the longest controlled studies in humans to date, both Type I and Type II insulin-dependent diabetics used a novel inhaled dry powder insulin delivery system for 3 months for meal time glucose control. The study results indicate that inhaled insulin provides equivalent glucose control, measured by hemoglobin A1c, when directly compared to SC injection. Interim results from an additional study with Type II diabetics who were failing oral hypoglycemic agents suggest that adjunctive therapy with inhaled insulin markedly improved glycemic control with a low risk of hypoglycemia. In all the 3 month studies the system was efficacious, well tolerated, well liked, and resulted in reproducible results. A potential advantage of aerosol insulin is that it is more rapidly absorbed (serum peak at 5-60 min) and cleared than SC injection (peak at 60-150 min), which provides a more relevant and convenient therapy for meal time glucose control. The relative efficiency of insulin delivery by aerosol, compared to SC injection, has been estimated from the dose measured at the exit point of the aerosol device, and found to range between 8 and 25% of SC, depending on the study.     

Intermediate and long-acting insulins: a review of NPH insulin,insulin glargine and insulin detemir

ABSTRACT

Objective: To review intermediate- and long-acting insulins with specific emphasis on the newer insulin analogs.

Methods: A MEDLINE search, in English, was conducted with a cut-off of June 30, 2006, using the terms ‘NPH insulin’, ‘insulin analogs’, ‘insulin glargine’, ‘insulin detemir’ and ‘long-acting insulins’. All clinical trials from within the search period were included.

Results: The insulin analogs, insulin glargine and insulin detemir, were introduced in an attempt to improve glycemic control among patients with diabetes, without increasing the risk of hypoglycemia. This review indicates that both insulin analogs demonstrate better glycemic control than NPH insulin, based on measurements of HbA_1c, fasting glucose and intra-subject variability in blood glucose. This was accomplished with similar or reduced risk of hypoglycemia. Also, insulin detemir appears to be associated with less body weight increase than NPH insulin or insulin glargine.

Conclusion: The newer long-acting insulin analogs, insulin detemir and glargine, appear to provide better glycemic control than NPH insulin without increasing the risk of hypoglycemia.