门冬胰岛素治疗肝源性糖尿病32例

观察32例肝源性糖尿病患者三餐前皮下注射门冬胰岛素的治疗。除5例因肝病并发症死亡外，余27例患者8周内随病情好转血糖均明显下降，部分完全至正常，复查HbA1c也有不同程度下降（P〈0．05），所有患者均无严重低血糖发生。胰岛素治疗肝源性糖尿病不仅疗效好而且安全、注射方便。     

门冬胰岛素治疗肝源性糖尿病32例

观察32例肝源性糖尿病患者三餐前皮下注射门冬胰岛素的治疗。除5例因肝病并发症死亡外，余27例患者8周内随病情好转血糖均明显下降，部分完全至正常，复查HbA1c也有不同程度下降（P〈0．05），所有患者均无严重低血糖发生。胰岛素治疗肝源性糖尿病不仅疗效好而且安全、注射方便。     

利格列汀联合门冬胰岛素50治疗肝源性糖尿病患者疗效及HOMA-IR和HOMA-β水平变化

目的 观察应用利格列汀联合门冬胰岛素50治疗肝源性糖尿病患者的疗效及胰岛素抵抗指数(HOMA-IR)和胰岛β 细胞功能指数(HOMA-β)水平的变化.方法 2017年1月 ～2019年12月我院收治的98例非酒精性脂肪性肝病合并肝源性糖尿病患者被随机分为对照组49例和观察组49例,分别给予门冬胰岛素50或门冬胰岛素50...     

72例肝源性糖尿病患者临床疗效研究

目的分析和研究肝源性糖尿病的临床特点以及治疗方法与效果。方法选择该院消化内科被确诊为肝源性糖尿病的患者共72例,并对于患者临床资料进行系统性的分析与研究。结果因慢性轻、中、重度肝病而引发的肝源性糖尿病的患者,全部随着肝病的治愈或者好转而得到缓解。通过治疗观察,血糖稳定的患者占55.6%,血糖仍然偏高的患者占22.2%。其中,重肝及肝硬化的患者占12.5%。结论肝源性糖尿病通常是在慢性肝病的基础上诱发的糖尿病,通过积极地治疗原发性肝病,并加胰岛素来控制患者的血糖,能够获得良好的临床治疗效果。     

72例肝源性糖尿病患者临床疗效研究

目的：分析和研究肝源性糖尿病的临床特点以及治疗方法与效果。方法选择该院消化内科被确诊为肝源性糖尿病的患者共72例，并对于患者临床资料进行系统性的分析与研究。结果因慢性轻、中、重度肝病而引发的肝源性糖尿病的患者，全部随着肝病的治愈或者好转而得到缓解。通过治疗观察，血糖稳定的患者占55.6%，血糖仍然偏高的患者占22.2%。其中，重肝及肝硬化的患者占12.5%。结论肝源性糖尿病通常是在慢性肝病的基础上诱发的糖尿病，通过积极地治疗原发性肝病，并加胰岛素来控制患者的血糖，能够获得良好的临床治疗效果。     

门冬胰岛素治疗2型糖尿病的临床观察

目的　观察胰岛素类似物门冬胰岛素治疗 2型糖尿患者的临床疗效、安全性及耐受性。方法　以 42例 2型糖尿病患者随机分为两组 ,分别以门冬胰岛素和诺和灵R治疗 ,药物剂量根据血糖高低调整 ,比较治疗前后患者的全天七次血糖谱变化。结果　门冬胰岛素和诺和灵R两组均可有效降低血糖 (P <0 .0 1) ,降糖效果无明显差异 (P >0 .0 5 ) ,门冬胰岛素组低血糖发生率明显低于诺和灵R组 (P <0 .0 5 ) ,尤其无严重和进行性低血糖 ,且无任何注射不适和不便。结论　在2型糖尿病患者中应用门冬胰岛素降糖效果显著 ,安全性高 ,病人耐受性和依从性好     

肝源性糖尿病胰岛素代谢异常的临床分析

目的探讨肝源性糖尿病胰岛素代谢的临床特点及可能机制。方法对31例肝源性糖尿病与2型糖尿病患者均行OGTY试验,均检测血糖、胰岛素、C肽水平,并计算胰岛素敏感指数、胰岛素抵抗指数。结果肝源性糖尿病患者胰岛素敏感性高于2型糖尿病患者（P〈0．05）,胰岛素抵抗指数低于2型糖尿病患者（P〈0．05）。结论肝源性糖尿病患者血糖水平与肝功能受损程度有一定关系,需降糖治疗时,应首先采用胰岛素治疗。     

肝源性糖尿病的研究现状

肝源性糖尿病(hepatogenous d iabetes)是继发于慢性肝实质损害的糖尿病,1999年在日本糖尿病会议上将其归类为2型糖尿病的一种〔1〕。严重肝病导致的糖耐量异常,是影响患者预后的一个重要因素,除已明确其发病机制为胰岛素抵抗、胰岛素分泌代谢异常、升糖激素增多、乙丙型肝炎病     

肝源性糖尿病的糖代谢特征研究

２７例慢性肝病，据其是否合并糖尿病分为两组，并以２２例急性肝炎和４１例原发性糖尿病作对照。测定ＯＧＴＴ空腹及餐后２小时血糖、胰岛素及Ｃ肽浓度，并求出诸比值。结果表明ＩＲＩ（２ｈ／０°）和Ｃ／Ｉ（２ｈ）是肝源性糖尿病两项颇具特征性的实验室指标。     

门冬胰岛素联合甘精胰岛素治疗2型糖尿病的疗效观察

目的探讨三餐前门冬胰岛素联合甘精胰岛素对血糖控制较差的糖尿病患者的疗效。方法选择血糖控制较差的糖尿病患者60例,随机分为两组：一组以三餐前门冬胰岛素联合睡前甘精胰岛素治疗（Asp＋Gla组）,另一组以三餐前诺和灵R联合睡前诺和灵N治疗（RI＋NPH组）。比较两组治疗后血糖达标时间、FBG、2hBG、血糖波动、胰岛素用量、低血糖发生率。结果Asp＋Gla组降糖快速稳定,血糖达标时间短,治疗后FBG、2hBG更理想,日内血糖波动幅度小,低血糖发生率低,优于RI＋NPH组（P均〈0．05）。结论对血糖控制较差的2型糖尿病患者,三餐前门冬胰岛素联合睡前甘精胰岛素治疗,低血糖发生率低,降糖效果显著。     

Starting patients with type 2 diabetes on insulin therapy using once-daily injections of biphasic insulin aspart 70/30, biphasic human insulin 70/30, or NPH insulin in combination with metformin

Transitioning safely to insulin therapy when oral antidiabetic agents fail to provide adequate glycemic control is a critical aspect of care for the patient with type 2 diabetes mellitus (T2DM). We evaluated the clinical effectiveness of starting patients on a relatively simple regimen of once-daily injections of either biphasic insulin aspart 70/30 (10 min before dinner), NPH insulin (at 10 p.m.), or biphasic human insulin 70/30 (30 min before dinner) in combination with metformin. Enrolled patients had T2DM and inadequate glycemic control (AlC≥7.5%) on a previous regimen of metformin as monotherapy or in combination with a sulphonylurea. One hundred and forty (140) patients received metformin monotherapy for 4 weeks followed by 12 weeks of combination treatment with metformin and once-daily insulin injections. AlC levels decreased from baseline by 1.1–1.3% for patients in each of the three treatment groups. Overall, FPG values decreased from baseline by 31% (biphasic insulin aspart), 37% (NPH insulin), and 28% (biphasic human insulin). Subjects whose final FPG level was <126 mg/dl experienced the largest decreases in AlC values (−2.3%, −1.9%, −1.8%, respectively). All three treatment regimens were well tolerated. The results indicate that patients with T2DM can safely and effectively begin insulin therapy using once-daily injections of biphasic insulin aspart 70/30, biphasic human insulin 70/30, or NPH insulin in combination with metformin.     

Safety and effectiveness of biphasic insulin aspart 30 in people with type 2 diabetes switching from basal-bolus insulin regimens in the A1chieve study

AimsBiphasic insulin aspart 30 allows fewer daily injections versus basal-bolus insulin regimens, which may improve adherence and treatment outcome. This sub-analysis of the observational A₁chieve study assessed clinical safety and effectiveness of biphasic insulin aspart 30 in people with type 2 diabetes previously receiving basal-bolus insulin regimens.MethodsA₁chieve was an international, open-label, 24-week study in people with type 2 diabetes starting/switching to biphasic insulin aspart 30, insulin detemir or insulin aspart. This sub-analysis assessed patients switching from insulin glargine- or neutral protamine Hagedorn insulin-based basal-bolus insulin regimens to biphasic insulin aspart 30.Results1024 patients were included. At 24 weeks, glycated haemoglobin and fasting plasma glucose were significantly reduced from baseline in both cohorts (all p < 0.001). The proportion reporting any hypoglycaemia, major hypoglycaemia or nocturnal hypoglycaemia was significantly reduced after 24 weeks (all p < 0.05). No serious adverse drug reactions were reported. Both cohorts had significantly improved health-related quality of life (HRQoL; p < 0.001).Conclusions24 weeks after switching from basal-bolus insulin regimens to biphasic insulin aspart 30, glycaemic control and HRQoL were significantly improved, and hypoglycaemia was significantly reduced. This suggests that people with type 2 diabetes inadequately controlled on basal-bolus insulin regimens can consider biphasic insulin aspart 30.     

双时相门冬胰岛素30每日1次对2型糖尿病患者的疗效和安全性

目的 评价2型糖尿病患者每日1次应用双时相门冬胰岛素30治疗的有效性和安全性.方法 本研究为多中心、开放性、自身对照的临床观察性研究.2008年9月至2009年6月选取未接受降糖治疗或既往口服降糖药治疗血糖控制效果欠佳的2型糖尿病患者621例,平均年龄（56±11）岁,平均糖尿病病程（4.4±4.2）年（0～30年）,平均体重指数（25.5±2.9）kg/m2,平均糖化血红蛋白（HbA1c）8.5%±1.2%.使用每日1次双时相门冬胰岛素30,起始剂量和最终剂量分别为（0.16±0.05）U/kg、（0.20±0.07）U/kg.联合口服药治疗12周后评价其有效性和安全性,并探索不同基线因素对于疗效的影响.结果 治疗12周后,HbA1c下降了1.8%±1.1%.HbA1c＜6.5%的患者占30.8%,HbA1c＜7%的患者占65.5%.空腹血糖和餐后血糖均显著下降,8时点血糖平均值下降了（3.8±2.3）mmol/L.分别按基线糖尿病病程、HbA1c、注射时间和体重指数分层的分析结果显示,HbA1c达标率随着糖尿病病程的延长和HbA1c的升高而降低.在双时相门冬胰岛索30治疗中,非重度低血糖事件每年每例患者的发生率为1.83次.仅有1例（0.2%）患者发生1次重度（夜间）低血糖事件.患者治疗后体重较治疗前显著降低（P=0.0053）.结论 在未使用降糖治疗或已用口服降糖药但血糖控制不佳的2型糖尿病患者中,双时相门冬胰岛素30每日1次治疗作为胰岛素起始方案,可安全有效地降低血糖水平,尤其适用于HbA1c水平轻至中度升高,病程相对较短的患者.     

Comparison of the pharmacokinetics and pharmacodynamics of biphasic insulin aspart and insulin glargine in people with type 2 diabetes

Aims/hypothesis The pharmacokinetic and pharmacodynamic properties of biphasic insulin aspart (BIAsp 30) (30% soluble, 70% protaminated insulin aspart [IAsp]) and insulin glargine (IGlarg) were compared.Methods Twelve people with type 2 diabetes took part in two 24-h isoglycaemic clamp studies, 1 week apart. Patients were randomised to treatment with 0.5 U/kg of BIAsp 30 (0.25 U/kg at 08.30 h and 0.25 U/kg at 20.30 h) or 0.50 U/kg IGlarg at 08.30 h. Both insulins were given by subcutaneous injection into the anterior abdominal wall. The plasma glucose, glucose infusion rates, plasma insulin and C-peptide concentrations were measured.Results All 12 patients were men; mean (±SD) age was 58.8 (8.9) years, BMI 31.0 (3.0) kg/m² and HbA_1c 7.1 (0.6)%. Plasma glucose was constant throughout the 24-h clamp period. After each injection of BIAsp 30, glucose infusion rates increased, reaching a distinct peak approximately 3–5 h after injection. A much flatter postinjection profile was observed following IGlarg administration. Plasma insulin concentrations rose rapidly after each injection of BIAsp 30, reaching a distinct peak after approximately 2–3 h. A flatter plasma insulin profile reached a plateau approximately 6–16 h after IGlarg administration. Plasma C-peptide fell below baseline after both injections of BIAsp 30 but remained unaltered after IGlarg injection.Conclusions/interpretation The pharmacodynamic and pharmacokinetic profiles were 34 and 28%, respectively, higher following equivalent doses (0.5 U/kg) of BIAsp 30 given as two split doses than following IGlarg given as a single daily dose.     

An analysis of the short- and long-term cost-effectiveness of starting biphasic insulin aspart 30 in insulin-naïve people with poorly controlled type 2 diabetes

AimThis study aimed to assess the cost-effectiveness of starting insulin therapy with biphasic insulin aspart 30 (BIAsp 30) in people with type 2 diabetes inadequately controlled on oral glucose-lowering drugs in Saudi Arabia, India, Indonesia, and Algeria.MethodsThe IMS CORE Diabetes Model was used to evaluate economic outcomes associated with starting BIAsp 30, using baseline characteristics and treatment outcomes from the A₁chieve study. Time horizons of 1 and 30 years were applied, with country-specific costs for complications, therapies, and background mortality. Incremental cost-effectiveness ratios (ICERs) are expressed as cost per quality-adjusted life-year (QALY) in local currencies, USD, and fractions of local GDP per capita (GDPc). Cost-effectiveness was pre-defined using the World Health Organization definition of <3.0 times GDPc. Comprehensive sensitivity analyses were performed.ResultsIn the primary 30-year analyses, starting BIAsp 30 was associated with a projected increase in life expectancy of >1 year and was highly cost-effective, with ICERs of −0.03 (Saudi Arabia), 0.25 (India), 0.48 (India), 0.47 (Indonesia), and 0.46 (Algeria) GDPc/QALY. The relative risk of developing selected complications was reduced in all countries. Sensitivity analyses including cost of self-monitoring, treatment costs, and deterioration of glucose control with time showed the results to be robust. In a 1-year analysis, ICER per QALY gained was still cost-effective or highly cost-effective.ConclusionStarting BIAsp 30 in people with type 2 diabetes in the A₁chieve study was found to be cost-effective across all country settings at 1- and 30-year time horizons, and usefully increased predicted life expectancy.     

Three different premixed combinations of biphasic insulin aspart – comparison of the efficacy and safety in a randomized controlled clinical trial in subjects with type 2 diabetes

Aim:  To evaluate clinical efficacy and safety of biphasic insulin aspart (BIAsp) 30 twice daily (b.i.d.) vs. BIAsp 50 or BIAsp 70 (high-mix regimens) thrice daily (t.i.d.) all in combination with metformin in a 36-week clinical trial in subjects with type 2 diabetes.
Methods:  Efficacy measurements included haemoglobin A_1c (HbA_1c) and eight-point plasma glucose (PG); safety included adverse events (AEs) and hypoglycaemic episodes. The three treatment groups (approximately 200 subjects in each group) were well matched regarding sex ratio, ethnicity, age and body mass index.
Results:  After 12 weeks, 43% and 54% in the BIAsp 50 and 70 groups, respectively, switched their dinner insulin to BIAsp 30. Both high-mix regimens were non-inferior to BIAsp 30 b.i.d., as measured by change in HbA_1c, and the BIAsp %50 regimen was superior. The odds for meeting the American Diabetes Association and The American Association of Clinícal Endocrinologist HbA_1c targets of <7% and ≤6.5%, respectively, were significantly higher with the BIAsp 50 regimen than with BIAsp 30. A significantly lower PG level was achieved from lunch until 02:00 hours with both high-mix regimens compared with BIAsp 30 b.i.d. AEs were mild or moderate with all three regimens. Frequency of hypoglycaemic episodes was comparable for the BIAsp 50 and the BIAsp 30 b.i.d. regimens but was significantly higher with BIAsp 70 t.i.d.
Conclusions:  Glycaemic control improved with BIAsp 50 t.i.d. without higher incidence of hypoglycaemia compared with BIAsp 30 b.i.d.; with BIAsp 70 t.i.d. lower PG levels from lunch to 02.00 hours, but more hypoglycaemic episodes were obtained compared with BIAsp 30 b.i.d. (Clinical Trials.gov ID no: NCT00184574).     

每日3次诺和锐30治疗2型糖尿病疗效观察

目的 比较不同胰岛素强化治疗对T2DM的疗效.方法 240例T2DM患者随机分为两组:诺和锐30组(124例)日3次诺和锐30皮下注射;诺和灵组(116例)日4次重组人胰岛素治疗(三餐前半小时注射诺和灵R,睡前注射诺和灵N).结果 两组相比,诺和锐30组控制血糖更快,胰岛素用量更少,低血糖发生率更低.结论 日3次注射诺和锐30,能更有效控制血糖,但需警惕低血糖发生.