地特胰岛素、甘精胰岛素与中性鱼精蛋白锌胰岛素联合短效胰岛素治疗2型糖尿病的疗效观察

目的探讨地特胰岛素、甘精胰岛素与中性鱼精蛋白锌胰岛素联合短效胰岛素对2型糖尿病患者的疗效。方法90例2型糖尿病患者分别应用地特胰岛素、甘精胰岛素与中性鱼精蛋白锌胰岛素联合短效胰岛素治疗,比较3组治疗前后空腹血糖、餐后2h血糖、胰岛素用量及低血糖发生率。结果3组血糖均下降,但地特胰岛素组降糖效果更明显,且低血糖发生率低。结论与甘精胰岛素、中性鱼精蛋白锌胰岛素相比,地特胰岛素治疗新诊断的2型糖尿病疗效更好,低血糖发生率较低。     

动态血糖监测重组甘精胰岛素等剂量转换为原研甘精胰岛素治疗2型糖尿病1例病例分析

1例因血糖控制不佳伴肢体麻木刺痛而入院的T_2DM患者,入院后通过胰岛素泵强化治疗血糖控制良好后改为重组甘精胰岛素联合餐时胰岛素控制血糖,通过动态血糖监测仪发现血糖波动明显,等剂量转换原研甘精胰岛素后,血糖控制平稳,原研甘精胰岛素剂量由20u减量至18u,治疗期间未发生不良反应。结论:应用重组甘精胰岛素控制血糖不佳且波动较大,等剂量转换原研甘精胰岛素后血糖控制平稳。     

甘精胰岛素联合口服药治疗波动性高血糖观察

23例波动性高血糖的T2DM患者改用甘精胰岛素联合口服降糖药治疗，治疗前后做对照。结果治疗12周后患者的平均空腹血糖、血糖低谷、血糖高峰、日间血糖漂移、夜间低血糖均优于治疗前（P〈0.05）。结论应用甘精胰岛素联合口服降糖药可以明显减少T2DM患者的血糖波动性。     

甘精胰岛素在2型糖尿病强化治疗中的应用

目的探讨睡前皮下注射甘精胰岛素与睡前注射中效胰岛素（NPH）对血精控制较差糖尿病患者的疗效。方法将80例2型糖尿病患者分为睡前皮下注射甘精胰岛素组、睡前皮下注射NPH组，两组三餐前均皮下注射短效胰岛素．比较治疗后两组血糖达标时间、平均空腹血糖、血糖漂移、胰岛素用量、低血糖发生率。结果甘精胰岛素组在血糖达标时间、治疗后空腹血糖、日内血糖漂移、低血糖发生率方面均低于NPH组（P〈0．05）。结论糖尿病患者应用甘精胰岛素联合短效胰岛素治疗，降精效果显著，安全性高。     

甘精胰岛素联合早餐前谷赖胰岛素治疗在老年2型糖尿病中的临床应用研究

40例甘精胰岛素联合口服降糖药治疗血糖控制不佳的老年2型糖尿病患者,随机分为两组:甘精胰岛素联合谷赖胰岛素组(n=20)与门冬胰岛素30组(n=20)。甘精胰岛素联合谷赖胰岛素组在原治疗基础上加用早餐前谷赖胰岛素皮下注射,门冬胰岛素30组停用甘精胰岛素,改为门冬胰岛素30早晚餐前皮下注射,两组均联合或减少原口服药方案。根据血糖调整胰岛素剂量。观察12周,监测空腹血糖(FBG)、餐后2小时血糖(PBG)、糖化血红蛋白(HbA_(1c))、低血糖、体重增加情况等。结果:治疗前平均基线血糖、HbA_(1c)、BMI、病程等水平在两组相似。治疗后甘精胰岛素联合谷赖胰岛素组FBG水平低于门冬胰岛素30组,差异有统计学意义(P 0.01);门冬胰岛素30组PBG水平低于甘精胰岛素联合谷赖胰岛素组,差异有统计学意义(P 0.01); HbA_(1c)水平在两组无明显差异(P=0.34)。甘精胰岛素组联合谷赖胰岛素组症状性低血糖(血糖≤3.9mmol/L,且有低血糖症状[1])显著低于门冬胰岛素30组,差异有统计学意义(P 0.01)。结论:甘精胰岛素联合早餐前谷赖胰岛素皮下注射及口服降糖药与门冬胰岛素30一天早晚两次皮下注射联合口服降糖药相比,两种治疗方案均可以有效降低老年2型糖尿病患者的糖化血红蛋白,前者可以更加有效降低患者的空腹血糖,症状性低血糖发生率更低。     

甘精胰岛素联合瑞格列奈治疗2型糖尿病35例临床观察

目的评价甘精胰岛素联合瑞格列奈治疗2型糖尿病的临床疗效并探讨其作用机制。方法在基础治疗基础上,治疗组采用基础治疗及甘精胰岛素初始量0.2 u/Kg,并根据空腹血糖进行调整用量,瑞格列奈2 mg tid;对照组采用基础治疗并格列美脲2 mg qd。结果瑞格列奈联合应用甘精胰岛素对空腹血糖和餐后血糖都有良好的控制作用,餐后血糖控制明显优于对照组,研究用瑞格列奈联合甘精胰岛素对2型糖尿病有效率达91.4%,总体疗效评价上明显优于对照组。结论甘精胰岛素联合瑞格列奈治疗其作用机制互相补充,临床效果确切,值得临床推广。     

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。     

格列吡嗪控释片联用甘精胰岛素的疗效及β细胞功能变化

为探讨磺脲类继发性失效者联合甘精胰岛素的疗效，改用格列吡嗪控释片联合睡前注射甘精胰岛素（20例）或中性鱼精蛋白锌胰岛素（32例）。16周后两组血糖和HbA1c均下降，但甘精胰岛素组低血糖较少，且治疗后C肽升高。故联合甘精胰岛素有较好疗效，并可能改善β细胞功能。     

沙格列汀或格列美脲联合甘精胰岛素对2型糖尿病患者血糖波动影响的观察

目的观察沙格列汀联合甘精胰岛素及格列美脲联合甘精胰岛素对T2DM患者血糖波动的影响。方法 60例未接受胰岛素治疗且血糖控制不佳的T2DM患者被随机分为沙格列汀联合甘精胰岛素组和格列美脲联合甘精胰岛素组,共治疗12周。采用动态血糖监测系统(CGMS)监测血糖波动情况,观察BMI、FPG、HbA1c及胰岛素用量等指标。结果两组血糖控制均改善,沙格列汀联合甘精胰岛素组日内血糖平均波动幅度(MAGE)、日内血糖波动次数(NGE)、日间血糖平均绝对差(MODD)低于格列美脲联合甘精胰岛素组[(2.2±1.0)vs(4.1±1.9)mmol/L;(1.4±1.4)vs(2.6±1.5)次/d;(1.30±0.65)vs(2.60±0.90)mmol/L,P<0.05]。两组治疗后FPG及HbA1c均降低[沙格列汀联合甘精胰岛素组(10.5±2.1)vs(6.2±1.3)mmol/L,(8.7±1.2)%vs(6.3±1.1)%;格列美脲联合甘精胰岛素组(10.4±1.8)vs(6.1±1.4)mmol/L,(8.9±1.4)%vs(6.5±1.2)%](P均<0.01);沙格列汀联合甘精胰岛素组BMI低于格列美脲联合甘精胰岛素组[(22.2±2.4)vs(25.5±2.7)kg/m2](P<0.05)。结论沙格列汀联合甘精胰岛素可有效控制血糖,改善血糖波动,在血糖控制稳定性方面优于格列美脲联合甘精胰岛素。     

甘精胰岛素联合瑞格列奈与预混胰岛素治疗比较

56例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治疗组（n=30）和预混胰岛素组（n=26）。以两组FBG均达到〈6．1mmol／L为目标，共12周，结果：两组血糖均明显下降，甘精胰岛素组下降更显著，低血糖事件更少；结论：长效胰岛素联合瑞格列奈使继发性失效的T2DM患者血糖达标更好，低血糖事件的发生更少，依从性大大提高。     

Evaluation of the superiority of insulin glargine as basal insulin replacement by continuous glucose monitoring system

To evaluate the superiority of insulin glargine as basal insulin replacement by continuous glucose monitoring system (CGMS). Twenty-four patients with type 2 diabetes mellitus (T2DM) whose blood glucose was not well controlled with sulphanylureas were enrolled. At first, they were treated with extended-release glipizide (glucotrol XL) 5mg/d before breakfast for 2 weeks, then randomized to combination treatment with glargine (16 patients) or NPH (8 patients) and treated for 12 weeks. CGMS were carried in the second week after treatment with glucotrol XL, and in the 12th week after combination treatment. The data of CGMS showed: (1) When FPG were well controlled in both groups (glargine group versus NPH group: 6.0+/-1.0 mmol/L versus 5.8+/-1.3 mmol/L), the blood glucose level at 3:00 a.m. (5.1+/-0.9 mmol/L versus 4.2+/-0.8 mmol/L) were higher (P<0.05), TPG< or =3.0 mmol/L at night were lower (2.56+/-1.79 versus 5.88+/-1.96), and the rate of nocturnal hypoglycemia (1/16 versus 4/8) were less (P=0.028) in glargine group than those in NPH group. (2) CGMS showed that the daily blood glucose profile excursion were more smoother in glargine group than those in NPH group. In conclusion, it was confirmed with CGMS that compared with traditionally basal insulin replacement with NPH, the combination treatment with glargine injection at bedtime may be predominant for stabilizing the daily blood glucose profile excursion and decreasing the nocturnal hypoglycemia events incidence. So glargine may be a more ideal basal insulin replacement than NPH.     

A comparison of bedtime insulin glargine with bedtime neutral protamine hagedorn insulin in patients with type 2 diabetes: subgroup analysis of patients taking once-daily insulin in a multicenter, randomized, parallel group study

BACKGROUND: Basal insulin is frequently administered once daily. This subgroup analysis of a multicenter, randomized, parallel study compared insulin glargine (Lantus Aventis Pharmaceuticals, Bridgewater, NJ) with neutral protamine Hagedorn (NPH) insulin in patients with type 2 diabetes, evaluating only patients treated previously with once-daily NPH insulin. METHODS: Patients received bedtime insulin glargine or NPH insulin, with preprandial regular insulin. One hundred patients (mean age, 57.9 years; mean glycohemoglobin, 8.4%; mean fasting blood glucose, 167 mg/dL) were treated for up to 28 weeks. RESULTS: Patients treated with insulin glargine (n = 52) and NPH insulin (n = 48) achieved similar reductions from baseline in glycohemoglobin (-0.41% versus -0.46%) and fasting blood glucose (-22 mg/dL versus -22 mg/dL) at week 28. The proportion of patients reaching target fasting blood glucose (<120 mg/dL) at 28 weeks was 34.2% with insulin glargine and 24.4% with NPH insulin. Similar proportions of patients achieved glycohemoglobin less than 7% and less than 8% in both groups. Baseline and week-28 mean daily doses of insulin glargine (27.3 IU versus 36.4 IU) were similar to NPH insulin doses (25.5 IU versus 30.2 IU). However, significantly fewer patients reported one or more episodes of hypoglycemia with insulin glargine (46.2%) versus NPH insulin (60.4%; P < 0.05). Significantly fewer patients also reported one or more symptomatic episodes confirmed by blood glucose less than 50 mg/dL with insulin glargine (17.3%) versus NPH insulin (31.3%; P < 0.005). CONCLUSION: Bedtime insulin glargine is as effective as bedtime NPH insulin in improving glycemic control, with significantly less hypoglycemia.     

甘精胰岛素与格列美脲联合应用治疗口服降糖药控制不佳2型糖尿病的有效性和安全性

目的 评价甘精胰岛素(来得时~(R))与格列美脲(亚莫利~(R))联合应用治疗口服降糖药控制不佳的2型糖尿病的有效性和安全性.方法 采用随机、开放、低精蛋白锌胰岛素注射液(诺和灵N)平行对照和多中心临床研究方法.122例口服降糖药控制不佳的2型糖尿病患者随机分为睡前注射一次甘精胰岛素(n=62)或低精蛋白胰岛素(n=60),清晨口服3mg格列美脲两组,进行为期24周的观察.结果 (1)基线时除甘精胰岛素组口服降糖药物使用的时间显著长于低精蛋白胰岛素组之外,两组其他指标相似;(2)24周时,甘精胰岛素组与低精蛋白胰岛素组的平均HbA_(1C)分别下降了1.38%和1.41%,平均空腹血糖分别从12.30和11.90 mmol/L降至6.05和6.19 mmol/L,日平均血糖降幅分别为5.28和4.56 mmol/L;(3)试验结束时,甘精胰岛素组和低精蛋白胰岛素组分别有46.8%和71.1%的患者发生症状性低血糖(156次和293次),其中严重低血糖事件分别为3.2%和15.0%(2次和21次),夜间低血糖分别为37.1%和61.7%(87次和229次),两组间差异均具有显著统计学意义(P<0.05或P<0.01);(4)甘精胰岛素组与低精蛋向胰岛素组的日平均胰岛素剂量分别从9.7 IU和9.8 IU增至32.5 IU和29.5 IU.结论 与低精蛋白胰岛素比较,睡前注射一次甘精胰岛素和清晨口服3 mg格列美脲联合应用可使口服降糖药控制不佳的2型糖尿病患者得到良好控制,且严重低血糖和夜间低血糖的发生率降低;作为基础胰岛素治疗,甘精胰岛素优于低精蛋白胰岛素.     

动态血糖监测甘精胰岛素治疗老年2型糖尿病的研究

目的通过动态血糖监测（CGMS），评估甘精胰岛素治疗老年2型糖尿病（T2DM）的疗效和安全性。方法对39例口服药联合治疗空腹血糖控制不佳的老年T2DM患者，加用甘精胰岛素（IG）和中性鱼精蛋白锌胰岛素（NPH）睡前皮下注射，治疗12周。治疗前后测定空腹血糖（FPG）、餐后2h血糖（2hPG）、糖化血红蛋白（HbAlc）、空腹C肽及餐后2hC肽等，并进行比较。结果治疗后，2组血糖和HbAlc均较治疗前下降（P〈0．05或P〈0．01），IG组血糖下降更明显（P〈0．05），2组HbAlc无明显差异（P〉0．05），IG组治疗后餐后2hC肽水平提高（P〈0．05）。CGMS显示IG组24h血糖曲线平缓，血糖达标时间延长，夜间低血糖的发生率低（P〈0．01）．血糖波动幅度小。结论IG作为老年T2DM患者的基础胰岛素替代治疗，血糖控制达标率高，胰岛素剂量控制更方便、安全，优于NPH。     

How do detemir and glargine compare when added to oral agents in insulin-naïve patients with type 2 diabetes mellitus?

In this Practice Point commentary, I describe the findings and limitations of a 52-week, open-label, noninferiority, head-to-head comparison study of the basal insulin analogs detemir and glargine. Rosenstock et al. enrolled 582 insulin-na?ve individuals with type 2 diabetes mellitus inadequately controlled with oral antidiabetic agents. Participants were randomly allocated to receive either detemir or glargine, titrated to a target fasting plasma glucose level 相似文献   

Efficacy of conversion from bedtime NPH insulin to morning insulin glargine in type 2 diabetic patients on basal-prandial insulin therapy

In normal subjects, approximately half of the daily insulin requirement constitutes basal insulin. We investigated whether increasing the dose of insulin glargine up to half of the total insulin requirement could lead to better glycemic control in type 2 diabetic patients who were treated on basal-prandial insulin therapy. A total of 62 patients with type 2 diabetes on mealtime rapid-acting insulin analogue and bedtime NPH were randomized to either continuation of bedtime NPH (n=31) or morning glargine (n=31) for 6 months while continuing the aspart/lispro at each meal. The two groups were matched for age, sex, diabetes duration, BMI, HbA(1C), endogenous insulin secretion, and proportion of numbers using aspart/lispro and using oral hypoglycemic agents. The dose of insulin glargine was increased by 2-4 units to meet the target fasting blood glucose, whereas the dose of NPH was principally unchanged as a control group. Mean HbA(1C) at baseline was similar between patients with glargine and NPH (7.2% versus 6.9%). The percentage of glargine dose increased significantly (31% at baseline to 48% at 6 months) without any significant changes in total insulin dose. Mean HbA(1C) at 3 months was 6.6% with glargine and 7.0% with NPH (P<0.0001, adjusted mean change between-treatment difference 0.6% [95% CI 0.3-0.9]), and the values at 6 months were 6.6% and 6.9%, respectively (P=0.007). Frequency of hypoglycemia did not differ between the groups. Increasing the dose of glargine without changing the total daily insulin dose resulted in significantly better glycemic control in type 2 diabetic patients on basal-prandial insulin therapy. Conversion from bedtime NPH to morning glargine appears efficacious with no increase in frequency of hypoglycemia.     

A randomized multicentre trial of insulin glargine compared with NPH insulin in people with type 1 diabetes

BACKGROUND: To compare insulin glargine with NPH human insulin for basal insulin supply in adults with type 1 diabetes. METHODS: People with type 1 diabetes (n = 585), aged 17-77 years, were randomized to insulin glargine once daily at bedtime or NPH insulin either once- (at bedtime) or twice-daily (in the morning and at bedtime) according to their prior treatment regimen and followed for 28 weeks in an open-label, multicentre study. Both groups continued with pre-meal unmodified human insulin. RESULTS: There was no significant difference between the two insulins in change in glycated haemoglobin from baseline to endpoint (insulin glargine 0.21 +/- 0.05% (mean +/- standard error), NPH insulin 0.10 +/- 0.05%). At endpoint, self-monitored fasting blood glucose (FBG) had decreased similarly in each group (insulin glargine -1.17 +/- 0.12 mmol/L, NPH insulin -0.89 +/- 0.12 mmol/L; p = 0.07). However, people on >1 basal insulin injection per day prior to the study had a clinically relevant decrease in FBG on insulin glargine versus NPH insulin (insulin glargine -1.38 +/- 0.15 mmol/L, NPH insulin -0.72 +/- 0.15 mmol/L; p < 0.01). No significant differences in the number of people reporting >or=1 hypoglycaemic episode were found between the two groups, including severe and nocturnal hypoglycaemia. Insulin glargine was well tolerated, with a similar rate of local injection and systemic adverse events versus NPH insulin. CONCLUSIONS: A single, bedtime, subcutaneous dose of insulin glargine provided a level of glycaemic control at least as effective as NPH insulin, without an increased risk of hypoglycaemia.     

Glargine is superior to neutral protamine Hagedorn for improving glycated haemoglobin and fasting blood glucose levels during intensive insulin therapy

AIM: To compare glycaemic control and symptomatic hypoglycaemia rates with glargine versus neutral protamine Hagedorn (NPH) in poorly controlled type 1 diabetes patients. METHODS: Patients (n = 125) received preprandial insulin lispro and either glargine (n = 62) or NPH (n = 63) at bedtime for 30 weeks in a multicentre, randomized, single-blind (a blinded investigator made titration decisions) study. Basal insulin dosage was titrated to achieve fasting blood glucose (FBG) values < 5.5 mmol/L. RESULTS: Baseline characteristics were similar for the two groups (mean diabetes duration 17.5 +/- 10.1 years) except mean glycated haemoglobin (HbA(1c)), which was lower in the glargine versus NPH group (9.2 +/- 1.1% vs 9.7 +/- 1.3%; P < 0.02). At end-point, mean HbA(1c) was 8.3 versus 9.1% for the glargine versus NPH groups. Adjusted least-squares mean (LSM) change from baseline was -1.04 versus -0.51%, a significant treatment benefit of 0.53% for HbA(1c) in favour of glargine (P < 0.01). Mean baseline FBG were similar for the glargine and NPH groups (11.2 vs 11.4 mmol/L). The means for end-point FBG were 7.9 versus 9.0 mmol/L. Adjusted LSM change from baseline was -3.46 versus -2.34 mmol/L, with a significant difference of 1.12 mmol/L in favour of glargine (P < 0.05). There were similar total numbers of daytime mild, moderate or severe hypoglycaemia episodes in the two treatment arms. However, significantly fewer moderate or severe nocturnal hypoglycaemic episodes were observed in the glargine group (P = 0.04 and P = 0.02). CONCLUSION: Glargine is superior to NPH for improving HbA(1c) and FBG levels during intensive insulin therapy in patients with type 1 diabetes, and is associated with less severe nocturnal hypoglycaemia.