优泌乐50和优泌林30R治疗2型糖尿病的疗效对比分析

目的比较预混胰岛素类似物（优泌乐50）和预混人胰岛素（优泌林30R）治疗口服磺脲类降糖药继发失效的2型糖尿病的疗效。方法本研究为持续12周的随机、开放实验,48例口服降糖药继发失效的2型糖尿病患者随机分为优泌乐50治疗组和优泌林30R治疗组,治疗12周,观察两种不同治疗方法患者糖化血红蛋白（HbA1c）、空腹血糖、餐后2h血糖、低血糖发生率、胰岛素用量的差异。结果显示接受优泌乐50治疗组餐后2h血糖控制好于优泌林30R治疗组（P〈0.01～0.05）;优泌乐50治疗组胰岛素用量更少（P〈0.05）,糖化血红蛋白、空腹血糖两组差异无统计学意义（P〉0.05）;低血糖发生率优泌乐50治疗组较优泌林30R组发生率低。结论优泌乐50治疗2型糖尿病控制餐后血糖优于优泌林30R,低血糖发生率低于优泌林30R,同等疗效,优泌乐50治疗组更节省胰岛素。     

优泌乐25和优泌林70/30治疗2型糖尿病磺脲类药物继发性失效患者的临床观察

目的：比较优泌乐25和优泌林70/30治疗2型糖尿病继发性磺脲类药物失效患者的临床疗效和安全性。方法93例2型糖尿病继发性磺脲类药物失效患者随机分为两组,分别予以皮下注射优泌乐25或优泌林70/30治疗3月,比较两组患者空腹血糖（FBG）、餐后血糖（PBG）、糖化血红蛋白（HbA1c）及低血糖发生率。结果两组患者FBG、PBG及HbA1c均较治疗前显著降低（P〈0.05）,优泌乐25组FBG、PBG及HbA1c低于优泌林70/30组,且优泌乐25组低血糖发生率低于优泌林70/30组（P〈0.05）。结论优泌乐25较优泌林70/30可更有效控制2型糖尿病继发性磺脲类药物失效患者血糖和HbA1c,并减少低血糖发生率。     

二甲双胍联合预混人胰岛素治疗2型糖尿病的临床观察

目的观察二甲双胍与预混人胰岛素治疗2型糖尿病的临床效果。方法选择66例患者并随机分为观察组和对照组。观察组用二甲双胍和预混人胰岛素治疗,对照组单用预混人胰岛素治疗,6月后观察2组两组患者的空腹血糖(FBG)、餐后2h(2hPG)、糖化血红蛋白(HbA1c)变化。结果2组患者治疗后空腹血糖(FBG)、餐后2h(2hPG)、糖化血红蛋白(HbA1c)均明显下降,差异有统计学意义。观察组在2hPG、HbA1c达标率方面较对照组高,差异有统计学意义。结论二甲双胍联合预混人胰岛素治疗2型糖尿病可以使患者血糖得到有效控制,治疗达标率高,值得在临床中应用。     

精蛋白锌重组赖脯胰岛素混合注射液(50R)治疗2型糖尿病60例

目的:研究精蛋白锌重组赖脯胰岛素混合注射液(50R)(优泌乐50,LM50)治疗2型糖尿病的临床疗效。方法:选择门诊与病房60例口服降糖药控制不佳的2型糖尿病患者,先进行为期10 d的优泌灵70/30导入期治疗。然后随机将患者分成A,B两组,A组改用优泌乐50,B组继续应用优泌灵70/30,每隔3 d监测血糖谱,并根据血糖调整胰岛素用量。两组患者肥胖者均使用二甲双胍,不用胰岛素促泌剂及其他口服降糖药物。治疗12周后,采用交叉研究,A,B两组互换治疗方案,胰岛素总量等量互换,口服二甲双胍不变,观察并比较12周和24周后两组空腹血糖(FBG),早餐后2 h血糖(2 h-PBG,早),晚餐后2 h的血糖(2 h-PBG,晚),糖化血红蛋白(HbA1C),发生可察觉的低血糖的次数,以及胰岛素总量等各项指标的变化,从而比较两组治疗效果。结果:A,B两组在血糖总体的控制上无显著性差异,即两组治疗后HbA1C比较无显著性差异,但在餐后血糖的控制以及低血糖的发生率上优泌乐50与优泌灵70/30有显著性差异。提示优泌乐50控制餐后2 h血糖效果更好,低血糖发生率更低。结论:优泌乐50治疗2型糖尿病疗效肯定,对餐后血糖的控制与优...     

优泌乐25治疗2型糖尿病的临床观察

目的观察优泌乐25治疗2型糖尿病的临床疗效。方法选择52例需胰岛素治疗的2型糖尿病患者,随机分为两组,A组为优泌乐25组,B组为优泌林70/30组,治疗12周。结果两组治疗后空腹血糖控制水平相似,A组餐后2h血糖控制优于B组,且HbA1c下降较B组明显,胰岛素用量少,低血糖发生率低。结论优泌乐25可以更加有效地控制餐后血糖,减少低血糖发生,安全性好。     

优泌乐 50 与优泌林 70/30 治疗 2 型糖尿病 50 例简

目的比较优泌乐50和优泌林70／30治疗2型糖尿病的临床疗效。方法选择口服降糖药物血糖控制不佳的2型糖尿病患者100例,随机分成优泌乐50组和优泌林70／30组,两组适当加用阿卡波糖或二甲双胍,不用胰岛素促泌剂,每隔3—7d监测4次血糖（空腹,早餐、中餐、晚餐后2h）,根据血糖调整胰岛素及口服药物用量,12周后比较两组的空腹血糖,早餐后2h血糖,晚餐后2h血糖,糖化血红蛋白,低血糖发生次数,胰岛素用量,观察其治疗效果。结果两组在空腹血糖及糖化血红蛋白的控制上差异无显著性,但在控制餐后2h血糖、低血糖发生率、胰岛素用量上有显著性差异（P〈0．05）。结论优泌乐50治疗2型糖尿病优于优泌林70／30。     

瑞格列奈联合二甲双胍治疗56例初发2型糖尿病的疗效观察

目的比较瑞格列奈联合二甲双胍和预混人胰岛素30R联合二甲双胍治疗初发2型糖尿病的疗效和安全性。方法入选56例初发2型糖尿病患者,将患者随机分成两组,观察治疗组27例,对照治疗组29例,在饮食控制、运动锻炼的基础上,观察治疗组服用瑞格列奈联合二甲双胍（其中初始剂量：二甲双胍0.253次/d、瑞格列奈1mg3次/d）,并依据血糖调整药物剂量;对照治疗组采用预混人胰岛素30R联合二甲双胍（其中人胰岛素30R初始剂量为：0.4～0.6IU/（kg.d）,分早晚二次皮下注射、二甲双胍0.253次/d）,依据血糖结果调整胰岛素及二甲双胍的剂量。所有入选患者均检测空腹血糖、餐后2h血糖、糖化血红蛋白、空腹C-肽,治疗期间每3天监测空腹及三餐后2h血糖,并记录低血糖事件发生的次数。用药12周后,再次复查上述各项指标,并进行比较。结果空腹血糖、餐后2h血糖、糖化血红蛋白显著下降,C-肽显著升高。结论应用瑞格列奈联合二甲双胍与预混人胰岛素30R联合二甲双胍治疗初发2型糖尿病均能有效控制血糖,改善胰岛β细胞功能,两种治疗间无显著差别,但瑞格列奈用药组患者依从性好,低血糖发生率低。     

预混胰岛素联合二甲双胍治疗OADs失效的2型糖尿病临床疗效观察

目地探讨口服降糖药物(OADs)失效的2型糖尿病(T2DM)患者初次胰岛素治疗方案。方法符合标准的2型糖尿病患者28例,给予诺和灵30R联合二甲双胍治疗30周,比较治疗前后的空腹血糖(FPG)、餐后两小时血糖(2HPG)及糖化血红蛋白(HbA1c)的结果。统计学方法采用t检验。结果HbA1c良好达到率46%(13/28),理想达到率为32%(9/28),总达到率为78%(22/28)。治疗后FGP、2HPG和HbA1c与治疗前比较明显下降,有显著性差异(P<0.01)。结论作为OADs失效的2型糖尿病患者的初始胰岛素治疗方案,预混胰岛素联合二甲双胍治疗可以显著改善血糖控制水平,同时不增加低血糖发生危险和避免体重增加。     

磷酸西格列汀联合门冬胰岛素30治疗2型糖尿病临床疗效观察

目的：观察磷酸西格列汀联合门冬胰岛素30治疗2型糖尿病的临床疗效与安全性。方法接受门冬胰岛素30治疗的血糖控制不理想的2型糖尿病患者60例,随机分为西格列汀组和二甲双胍组,各30例。西格列汀组给予西格列汀100 mg/d口服,二甲双胍组给予二甲双胍1.0 g/d,两组根据血糖监测情况适时调整门冬胰岛素30用量,疗程12周。检测两组用药前后空腹血糖(FPG),餐后2 h血糖(2 h PG),糖化血红蛋白(HbA1c),观察不良反应。结果西格列汀组完成29例,二甲双胍组完成28例。两组患者的空腹血糖、餐后2 h血糖及糖化血红蛋白值均较治疗前明显下降,差异有统计学意义(P<0.05);治疗后两组比较,西格列汀组优于二甲双胍组(P<0.05)。均无严重不良反应。结论磷酸西格列汀联合门冬胰岛素30治疗2型糖尿病有明显疗效,可以更好控制血糖,无明显不良反应,耐受性好。     

优泌乐50治疗2型糖尿病的临床疗效观察

目的旨在研究优泌乐50治疗2型糖尿病临床疗效。方法选择门诊或病房60例血糖控制不佳的2型糖尿病患者,先进行为期10天的优泌灵70/30导入期治疗,导入期期间,两组病人均停用促胰岛素分泌剂,适当加用阿卡波糖,或二甲双胍。然后随机分成A、B两组,两组的一般情况有可比性,且经过10天的治疗后的血糖水平有可比性。A组改用优泌乐50,B组继续应用优泌灵70/30,每隔3天监测血糖谱,并根据血糖调整胰岛素用量。两组酌情调整二甲双胍或拜糖苹,不用胰岛素促泌剂。治疗3个月后,再次将A,B两组患者均进行为期10天的优泌灵70/30导入期治疗,方案与前面的导入期治疗相同,然后采用交叉研究,A,B两组互换治疗方案,胰岛素总量等量互换,口服药物不变,观察并比较12周,24周后两组空腹血糖（FBG）,早餐后2h血糖（2h-PBG,早）;晚餐后2h的血糖（2h-PBG,晚）;糖化血红蛋白（HbA1C）,发生可察觉的低血糖的次数,以及胰岛素总量等各项指标的变化,从而比较两组治疗效果。结果A,B两组在血糖总体的控制上没有显著性差异,即在糖化血红蛋白的控制上没有显著性差异,但在餐后血糖的控制以及低血糖的发生率上优泌乐50与优泌灵70/30,有显著性差异。提示优泌乐50控制餐后2h血糖效果更好,低血糖发生率更低。结论优泌乐50治疗2型糖尿病患者疗效肯定,对餐后血糖的控制存在优势。且低血糖发生率低。     

Defining the role of insulin lispro in the management of postprandial hyperglycaemia in patients with type 2 diabetes mellitus

The role of postprandial hyperglycaemia in contributing to the risk of both micro- and macrovascular complications in patients with diabetes mellitus is being increasingly recognized. In type 2 diabetes, there is a progressive shift in the relative contributions of postprandial and fasting hyperglycaemia to the overall glycaemic control as the disease progresses. For patients with fairly good glycaemic control (glycosylated haemoglobin [HbA(1c)] <8.5%), postprandial hyperglycaemia makes a relatively greater contribution to the overall glycaemic load than fasting hyperglycaemia, but in patients with poorer control, the relative contribution of the two states to the overall glycaemic load is reversed. This finding, coupled with epidemiological evidence that elevated postprandial glucose concentration is an independent risk factor for cardiovascular disease (CVD), and is associated with a greater CVD risk than elevated fasting glucose, points to the need to monitor and target postprandial glucose, as well as fasting glucose and HbA(1c) levels, when optimizing insulin therapy for patients with type 2 diabetes. When insulin therapy becomes necessary in patients with type 2 diabetes who can no longer be controlled with oral antihyperglycaemic therapy, use of short-acting insulin analogues with a rapid onset of action and capable of controlling postprandial glycaemic excursions when injected immediately before a meal, has advantages over regular human insulin in that they provide a more favourable time-action profile that mimics normal physiological insulin secretion. Among the available rapid-acting insulin analogues, insulin lispro has been shown to reduce postprandial glucose concentrations to a significantly greater degree than regular human insulin in patients with type 2 diabetes. Moreover, premixed combinations of insulin lispro with the longer acting analogue neutral insulin lispro protamine suspension in 25% : 75% or 50% : 50% combinations are significantly more effective in lowering postprandial blood glucose concentrations than premixed regular human insulin plus neutral protamine Hagedorn (NPH) 30% : 70%. The premixed insulin lispro combinations offer the advantage of fewer daily injections than intensive insulin therapy, and the convenience of not having to mix insulin preparations manually. Although it has yet to be conclusively established that targeting postprandial hyperglycaemia reduces CVD risk, the potential benefits of improved postprandial and interprandial hyperglycaemia favour the use of newer insulin analogues, such as insulin lispro and insulin lispro mixes, over conventional insulin therapy, whenever insulin therapy becomes necessary in patients with type 2 diabetes.     

Premixed insulin analogues for the treatment of diabetes mellitus

Premixed insulin analogues, consisting of rapid-acting and intermediate-acting insulin analogues, were developed to more closely mimic physiological endogenous insulin secretion and meet the needs of patients who require both basal and prandial insulin but wish to limit the number of daily injections. There is considerable variability in onset and duration of action, as well as peak insulin levels, obtained with human insulin formulations such as premixed human insulin 70/30. To overcome these limitations, premixed insulin analogues were developed. Peak insulin levels are twice as high and reached in half the time with the rapid-acting insulin component of a premixed insulin analogue. In the US, two premixed insulin analogue formulations are currently available: insulin lispro 75/25 (75% insulin lispro protamine suspension and 25% insulin lispro) and biphasic insulin aspart 70/30 (BIAsp 70/30; 70% insulin aspart protamine suspension and 30% insulin aspart). They are generally administered twice daily, just before breakfast and dinner. Data from various randomised trials show that both insulin lispro 75/25 and BIAsp 70/30 provide more effective postprandial control of blood glucose than premixed human insulin 70/30 or human insulin isophane suspension (NPH insulin). Longer-term glycaemic control, evaluated as changes in glycosylated haemoglobin, is comparable for premixed insulin analogues and premixed human insulin 70/30 in most studies. Three comparative, randomised trials have shown that patients with type 2 diabetes mellitus using premixed insulin analogues twice daily are more likely to reach glycaemic goals than those using only insulin glargine once daily. Some patients can also reach glycaemic goals with once-daily administration of a premixed insulin analogue. Although the incidence of hypoglycaemia is low, direct comparison across trials of premixed insulin analogues is difficult because of inconsistencies in reporting. Within trials, the incidence of both major (rare) and minor hypoglycaemic episodes during treatment with premixed insulin analogues is low and comparable with rates found with human insulin 70/30. Premixed insulin analogues can be safely used, and are effective and convenient for achieving overall glycaemic control in patients with diabetes. In addition, given the convenience of mealtime dose administration, compliance with insulin therapy may increase with premixed insulin analogues.     

精蛋白锌重组赖脯胰岛素混和注射液对初诊糖尿病血糖及胰岛功能的影响

目的探讨精蛋白锌重组赖脯胰岛素混和注射液（优泌乐25）强化治疗对初诊2型糖尿病患者血糖及胰岛功能的影响。方法对60例初诊2型糖尿病患者进行2个月的优泌乐25治疗,观察治疗前后空腹血糖（FPG）及餐后2h血糖（2hPG）、糖化血红蛋白（HbA1c）、胰岛素抵抗指数、胰岛素分泌指数、胰岛素敏感指数、空腹胰岛素（FINS）与FPG比值。结果优泌乐25治疗后,FPG、2hPG、HbA1c、胰岛素抵抗指数均较治疗前明显下降（P〈0．01）;空腹C肽的分泌、胰岛素、FINS与FPG比值、胰岛素分泌指数、胰岛素敏感指数均较治疗前明显升高（P〈0．01）。结论优泌乐25强化治疗能显著改善初诊2型糖尿病患者的血糖及胰岛功能。     

赖脯胰岛素25不同给药次数治疗2型糖尿病的有效性及安全性

目的评价对于血糖初诊高、降糖口服药及其他类胰岛素控制血糖效果较差的2型糖尿病（DM）患者,应用赖脯胰岛素治疗的临床疗效、安全性观察。方法选取2008年1月-2010年12月本院采用赖脯胰岛素25治疗的120例2型DM患者,66例2次／d皮下注射（2次组）;54例3次／d皮下注射（3次组）。随访3个月,对比两组患者临床资料差异情况。结果两组经14d治疗后血糖值均较治疗前下降明显（P〈0．001）,两组血糖下降差异无统计学意义（P〉0．05）。住院期间2次组发生低血糖事件17例,3次组发生1l例;2次组胰岛素用量为（0．44±0．14）U／kg,3次组胰岛素用量为（0．62±0．16）U／kg,组间差异有统计学意义（P〈0．05）。结论2次／d或3次／d赖脯胰岛素25皮下注射,对2型DM患者,均可控制HbAlc。及血糖,3次／d效果较满意且无增加低血糖风险的发生率。     

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。     

Insulin lispro protamine suspension in the treatment of patients with type 1 and type 2 diabetes mellitus: a systematic review of published data

INTRODUCTION: Insulin lispro protamine suspension (ILPS) is a protamine-based insulin lispro formulation that allows 24-h coverage while limiting the number of daily injections. ILPS was developed to be the basal insulin component of premixed biphasic formulations with insulin lispro, i.e., the lispro/ILPS 25/75 and 50/50 mixed compounds, but has recently also been marketed as a basal insulin analog formulation, with an indication for the therapy of diabetic patients. AREAS COVERED: This article reviews the available literature on pharmacokinetics/pharmacodynamics (PK/PD), efficacy and safety of ILPS administered as basal insulin, or in premixed biphasic formulations, in patients with type 1 and type 2 diabetes mellitus. EXPERT OPINION: The results of this review suggest that ILPS may be associated with a favorable time-action profile, basal and postprandial glycemic control, and efficacy in terms of rates of patients reaching glycosylated hemoglobin targets; an increased risk of hypoglycemic episodes, compared to other basal insulins, seems to be related to the percentage of patients upgrading from once- to twice-daily injections. This increased risk might be linked with the concomitant use of insulin secretagogues in patients on higher daily dosages and is generally not observed in patients using one injection of ILPS a day. Thus, ILPS can be considered a valid option both as basal insulin and as basal component of the actual premixed formulations of lispro for the therapy of diabetic patients.     

Efficacy and safety of a premixed versus a basal-plus insulin regimen as intensification for type 2 diabetes by timing of the main meal

Objective: To describe the efficacy and safety of premixed insulin lispro protamine suspension 75%/insulin lispro solution 25% (LM25) twice daily (bid) versus basal insulin glargine plus prandial insulin lispro (IGL), both once daily, according to main meal timing. Methods: Data were obtained post hoc from a 24 week, randomized, open-label study comparing LM25 and IGL as insulin intensification in patients with type 2 diabetes inadequately controlled with once daily basal insulin glargine plus metformin and/or pioglitazone (ClinicalTrials.gov identifier: NCT01175824). Patients administered LM25 bid before breakfast and the evening meal, insulin glargine at bedtime and insulin lispro before the day’s main meal (meal with the highest 2?hour postprandial glucose level during screening). Patients were grouped by main meal. Changes in glycosylated hemoglobin (HbA1c) and bodyweight were summarized using likelihood-based mixed models; hypoglycemia incidence was compared between treatments using Fisher’s exact test. Results: Overall, 476 patients (LM25, n?=?236; IGL, n?=?240) were randomized. In all main meal groups, with both insulin regimens, mean HbA1c significantly decreased from baseline to 24 weeks (p?<?0.0001). Patients whose main meal was in the evening had a greater bodyweight increase with LM25 than with IGL (p?=?0.015), and a smaller proportion of these patients experienced total (p?=?0.027) and nocturnal (p?=?0.006) hypoglycemia with LM25 compared with IGL. Patients whose main meal was lunch experienced more nocturnal hypoglycemia with LM25 than with IGL (p?=?0.030). Study limitations include that this was a post hoc analysis and no assessments ensured that: SMBG results determined timing of the main meal, each patient’s main meal remained unchanged throughout the study, or patients administered insulin lispro with that meal. Conclusions: Glycemic control improved in patients receiving either LM25 or IGL, irrespective of main meal timing. Both regimens can be used in patients with inadequate glycemic control who are in need of insulin intensification.     

2种方案治疗老年2型糖尿病的疗效观察

目的观察2种不同的联合用药方法对老年2型糖尿病患者的疗效。方法选择老年2型糖尿病患者80例,随机分为2组,A组给予预混人胰岛素 马来酸罗格列酮、B组给预混人胰岛素 阿卡波糖 二甲双胍进行治疗,对治疗效果进行统计学分析。结果两组治疗后血糖水平、糖化血红蛋白均较治疗前有明显下降(P<0.01)。结论联合用药可改善老年2型糖尿病患者的血糖控制。     

预混胰岛素类似物联合瑞格列奈对2型糖尿病合并肺结核患者的免疫功能和血糖的影响

目的探讨预混胰岛素类似物与瑞格列奈在糖尿病合并肺结核中的应用价值。方法选择于2010年8月至2013年8月闻人院治疗的2型糖尿病合并肺结核患者164例,随机分成2组。2组患者均在肺结核四联化疗的基础上,对照组采用预混胰岛素类似物诺和锐30R联合安慰剂,观察组采用预混胰岛素类似物诺和锐30R联合瑞格列奈进行降糖治疗,疗程均为3个月。检测治疗前后所有患者的T淋巴细胞亚群绝对值水平、血糖相关指标和血糖波动情况。结果治疗后,2组患者T细胞亚群绝对值水平均高于治疗前,且观察组患者的CD3＋、CIM＋、CD8＋、CD4＋／CD8＋水平均高于对照组;2组患者血糖水平均低于治疗前,且观察组患者的FBG、2hPBG、HbAle水平,以及血糖波动次数和日间血糖平均差绝对值均低于对照组。结论预混胰岛素联合瑞格列奈可以更为有效地改善免疫功能、降低血糖水平和控制血糖波动,是糖尿病合并肺结核患者理想的降糖方案之一。