双相门冬胰岛素短期强化治疗2型糖尿病的剂量及相关影响分析——附64例分析

目的：研究2型糖尿病患者接受双相门冬胰岛素（诺和锐30）短期强化治疗的剂量及其影响因素。方法：空腹血糖等于或超过10mmol／L,糖化组红蛋白A1C等于或超过8．6％的64例2型糖尿病患者,采用双相门冬胰岛素三餐前皮下注射治疗,按需配合二甲双胍250mg或阿卡波糖25mg的降低餐后血糖,使患者早、晚餐前血糖平均值控制至4．4—6．1mmol／L,3餐后2h血糖平均值控制至4．4～10．0mmol／L。记录血糖最初达标时的双相门冬胰岛素剂量、血糖达标时间,比较血糖、体重指数及病程基线不同患者的双相门冬胰岛素用量的差异。结果：治疗达标时,所有患者平均餐前血糖得以控制的时间为（7．0±2．6）d,平均餐后2h血糖得以控制的时间为（6．2±2．6）d。双相门冬胰岛素的平均用量为0．44U／（kg·d）。空腹血糖等于或超过13mmol／L组双相门冬胰岛素剂量明显大于空腹血糖10—13mmol／L组;体重指数低于23kg／m2组双相门冬胰岛素剂量明显大于体重指数等于或超过23kg／m2组;病程长者双相门冬胰岛素剂量明显高于病程短者（均为P〈0．05）。结论：双相门冬胰岛素治疗强化剂量平均为0．44U／（kg·d）。在使用双相门冬胰岛素进行短期强化治疗时,应根据患者的基线血糖、体重指数、病程调整药物剂量,使治疗达到最佳效果。     

胰岛素类似物治疗初诊腹型肥胖的2型糖尿病临床观察及随访

目的观察使用胰岛素类似物治疗初诊腹型肥胖2型糖尿病患者的疗效及安全性,并在出院后改用"一针一药"方案,直至停用胰岛素,随访治疗方案的变化。方法选取2007年3月至2010年11月符合纳入标准的40例糖尿病住院男性患者,随机分为2组,A组20例采用门冬胰岛素每日三餐前联合睡前1次甘精胰岛素注射;B组20例门冬胰岛素每日三餐前注射。2组均采用胰岛素强化治疗直至血糖控制达标,观察治疗前后空腹血糖(FBG)、餐后2小时血糖(2hPPG)、C肽、血糖达标时间和达标时胰岛素使用量,以及低血糖发生情况。出院后改为口服药配合晚间注射1次甘精胰岛素,每日胰岛素总量<20U时停用胰岛素,仅用口服药(非促泌剂)配合运动饮食治疗,观察至复用胰岛素时的持续时间。结果全部患者治疗后血糖水平显著下降,C肽水平显著增加,2组间比较差异无统计学意义(P均>0.05);A组血糖达标时间短,胰岛素用量少,低血糖发生率高。出院随访显示仅使用口服药物仍可在一定时间内良好控制血糖。结论初诊腹型肥胖的2型糖尿病患者使用胰岛素类似物强化治疗安全、有效。     

甘精胰岛素联合那格列奈治疗2型糖尿病的临床观察及护理

目的观察甘精胰岛素联合那格列奈治疗2型糖尿病的疗效。方法选择2型糖尿病患者80例,随机分为3组:A组22例为口服降糖药物组;B组28例为甘精胰岛素联合那格列奈组;C组30例为预混胰岛素组。治疗12周后观察A、B、C 3组患者血糖达标的时间,空腹血糖、餐后2h血糖、糖化血红蛋白的变化情况及低血糖的发生率。结果在饮食及运动达标的前提下A、B、C 3组空腹血糖、餐后2h血糖达到理想水平的时间分别为8.2d、7.1d、6.5d,空腹血糖、餐后2h血糖、糖化血红蛋白较前明显下降,其中B、C 2组糖化血红蛋白下降的幅度远远超过A组;A、B、C 3组因空腹及餐后2h未达理想水平退出观察的病例分别为8例、4例、7例,严重低血糖发生的例数为3例、3例、6例。结论甘精胰岛素联合那格列奈治疗2型糖尿病前,对患者进行针对性的心理指导、胰岛素注射技术培训并给予口服降糖药物指导患者治疗,效果满意。     

两种不同胰岛素治疗糖尿病的疗效对比

我们应用诺和诺德公司生产的合成人胰岛素（诺和灵Ｒ笔芯）及胰岛素注射笔治疗２４例糖尿病，同时与同期动物胰岛素治疗２６例糖尿病患者作对比，观察空腹及餐后２小时血糖、高血糖控制时间及血糖控制满意时的每日胰岛素用量。现将治疗情况报道如下。１ 对象与方法１．１ 对象　５０例患者均符合１９８５年ＷＨＯ糖尿病诊断标准，并有胰岛素应用指征，无严重并发症，经临床和实验室检查，胰岛素和Ｃ肽释放试验分型。随机分为Ａ、Ｂ两组，Ａ组２４例。１型糖尿病４例，２型糖尿病２０例，男１１例，女１３例，年龄３４～６７岁，平均５３岁，…     

2型糖尿病皮下注射甘精胰岛素与胰岛素泵强化治疗的对比研究

目的观察睡前皮下注射甘精胰岛素与用胰岛素泵强化治疗2型糖尿病患者的疗效及效价。方法将60例2型糖尿病患者随机分为A、B2组,每组30例,均进行胰岛素强化治疗。A组：三餐进餐时皮下注射诺和锐＋睡前皮下注射甘精胰岛素;B组：胰岛素泵持续胰岛素（诺和灵R）泵入＋三餐前15min注入餐时峰值。比较治疗后2组血糖达标时间和成本,治疗后空腹血糖、餐后2h血糖、胰岛素用量、低血糖发生率。结果2组患者治疗后空腹血糖及餐后2h血糖、血糖达标时间、胰岛素用量差异无统计学意义（P均〉0.05）,患者达标成本A组明显低于B组（P〈0.01）。结论皮下注射甘精胰岛素强化治疗与胰岛素泵强化治疗的疗效相当,可良好地控制高血糖,降低低血糖发生率,并具有更好的成本-效价比。     

外源性胰岛素对2型糖尿病的骨密度和骨代谢指标的影响

目的研究外源性胰岛素对2型糖尿病(T2DM)患者的骨密度及骨代谢指标的影响。方法运用QCT测定43例年龄≥50岁健康对照组以及39例年龄≥50岁使用口服降糖药控制血糖的T2DM患者(口服药物组)和36例使用胰岛素3年以上的≥50岁T2DM患者(胰岛素组)的腰椎骨密度,同时记录年龄、体质量指数、运动及日照时间、饮食习惯、糖尿病病程、绝经年限(女性),检测糖化血红蛋白、胰岛素及C肽(空腹及餐后2h)、血钙、磷、总碱性磷酸酶、骨钙素和尿钙。结果 (1)与对照组比较,口服药物组骨密度差异无统计学意义(P>0.05),(2)与口服药物组比较,胰岛素组骨密度明显增加;(3)胰岛素组骨钙素和餐后2小时胰岛素水平明显高于健康对照组和口服药物组,差异有统计学意义(P<0.01)。结论外源性胰岛素治疗对2型糖尿病骨质疏松有益,这可能与其体内胰岛素水平较高有关。     

胰岛素治疗初诊2型糖尿病的临床观察

目的：探讨胰岛素治疗对初诊2型糖尿病患者血糖控制及胰岛β细胞功能的影响。方法：42例初诊2型糖尿病患者接受胰岛素治疗1个月，观察治疗前后血糖、糖化血红蛋白及血C肽水平的情况，并随访胰岛素治疗后对长期血糖控制的影响。结果：胰岛素治疗1个月后，患者空腹血糖（FPG）、餐后2小时血糖（2hPG）、糖化血红蛋白（HbA1c）均明显下降（P〈0．05），空腹及餐后2小时血C肽水平明显升高（P〈0．05），有35例患者停用胰岛素，改口服降糖药物治疗，随访6个月，血糖控制理想。结论：胰岛素治疗初诊2型糖尿病不仅能较好控制血糖及明显降低HbA1C，而且在一定程度上能恢复胰岛β细胞的功能。     

短期胰岛素泵治疗对不同病程2型糖尿病患者胰岛β细胞功能的影响

目的观察胰岛素泵强化治疗2周对不同病程2型糖尿病患者胰岛β细胞功能及胰岛素抵抗改善的差异。方法选择不同病程的2型糖尿病患者共90例,根据病程长短分为新诊断糖尿病组（A组）、病程1～5年糖尿病组（B组）、病程5年以上糖尿病组（C组）,各组30例。对3组患者进行2周胰岛素泵强化治疗,以空腹血糖〈6.1 mmol·L-1,餐后2 h血糖〈8.0 mmol·L-1为治疗目标,治疗前后行标准馒头餐试验,检测3组患者空腹及餐后2 h的血糖、胰岛素、C肽,用稳态模型计算治疗前后的胰岛β细胞功能指数（Homa-β）,胰岛素抵抗指数（Homa-IR）。结果 A组和B组治疗后Homaβ-、空腹C肽均较治疗前升高,差异有统计学意义（P〈0.05）,而C组治疗后Homaβ-、空腹C肽较治疗前亦升高,但差异无统计学意义（P〉0.05）;A组的Homaβ-治疗前后的差值与B组比较,差异有统计学意义（P〈0.05）;强化治疗前后各组Homa-IR差异均有统计学意义（P〈0.05）。结论胰岛素强化治疗能改善病程较短的2型糖尿病患者的胰岛β细胞功能,新诊断的2型糖尿病患者获益更大。理想的血糖控制都能使胰岛素抵抗得到改善。     

拜糖平与胰岛素联合应用治疗糖尿病56例

单独应用胰岛素治疗糖尿病,血糖控制有时不理想,尤其是餐后血糖高是临床中经常遇到的问题。我院于2002年11月￣2005年11月对用胰岛素治疗而血糖控制不佳的2型糖尿病人56例合用拜糖平取得满意疗效。现报告如下:1临床资料1.1一般资料本组共56例,男31例,女25例;年龄49￣75岁,中位年龄62岁;均符合《现代内科学》2型糖尿病诊断标准,且对磺脲类药物原发或继发失效而在饮食运动治疗基础上注射胰岛素。这些病人血糖控制不满意,即餐前血糖高于7.0mmol/L和(或)餐后2h血糖高于10.0mmol/L,尤其是餐后2h血糖较高。本组患者均无严重心、肝、肾功能障碍,无…     

胰岛素强化治疗初诊2型糖尿病

目的探讨早期胰岛素强化治疗对初诊2型糖尿病的疗效。方法分析我院2006年1月至2007年12月短期应用胰岛素治疗初诊2型糖尿病患者36例,以同期口服药物治疗的初诊2型糖尿病患者40例为对照。初诊时空腹血糖（FBG）〉11．1mmo]／L,分别观察治疗2个月后各纽空腹血糖（FBG）、餐后2h血糖（PBG）、糖化血红蛋白（HbA1c）、胰岛素水平、C肽水平变化情况。结果经短期胰岛素强化治疗后,FBG、PBG、HbA1c显著下降,空腹及餐后2h胰岛素水平、C肽水平,比对照组明显增高,差异有统计学意义（P〈0．01）。结论初诊2型糖尿病患者早期胰岛素强化治疗比口服药物治疗能更有效地控制血糖水平,降低高糖毒性,减轻胰岛素抵抗,使胰岛β细胞功能恢复,可能对延缓糖尿病自然病程的进程,预防糖尿病慢性并发症有积极的意义。     

The human insulin analogue insulin lispro

Insulin lispro is a newly developed analogue of human insulin where the positions of the amino acids lysine and proline have been switched at the end of the B chain of the insulin molecule. Insulin lispro with lysine at position B28 and proline at position B29 has a weaker tendency for self-association than human insulin. This leads to three major differences in the pharmacokinetics: the action begins faster, has a higher peak and the duration is shorter than with human insulin. Thus, insulin lispro has a more precise action profile for the mealtime than human regular insulin. Insulin lispro is recommended to be injected within 15 min before the meal in contrast to 30–40 min for human insulin. In clinical trials with insulin lispro, the postprandial rise of blood glucose is smaller, the rate of hypoglycaemia is lower particularly at night-time, the need for snacks is smaller and the patient preference is better than with human insulin. The long-term control as reflected by an improvement in the HbA_]c level is better with insulin lispro than with human regular insulin, provided that an appropriate basal insulin regimen is used to take into account the shorter duration of action. A few patients have been described who have a severe resistance to human insulin but who have been succesfully treated with insulin lispro. Insulin lispro was designed to be used as a mealtime insulin, and it is a step forward in the treatment of diabetic patients using a basal-bolus insulin regimen.     

Inhaled insulin (pulmonary administered insulin)]

The first report according to Inhaled insulin came out in 1924. Recent clinical trials of inhaled insulin made a real story to insulin-treated diabetic patients. Among some companies, insulin preparation of Pfizer company group consists of dry insulin dispersed by aerosol into particles sufficiently fine to drift into the distal twigs of the respiratory tree. Skylar et al in 2001 reported a randomized proof-of-concept study of inhaled insulin in type 1 diabetes mellitus. The result showed the same efficacy to the same time injections of regular insulin. Other reports showed the efficacy of inhaled insulin comparable to that of lispro insulin and the same action to not only type 1 but also type 2 diabetic patients.     

Changes in insulin resistance with long-term insulin therapy

Thirteen newly diagnosed diabetic subjects, 5 with insulin-dependent diabetes mellitus (IDDM) and 8 with non-insulin-dependent diabetes mellitus, mean age 37.1 yr (range 25-64 yr), underwent glucose-clamp studies at diagnosis of diabetes at plasma glucose 200 mg/dl. Each subject was then treated twice daily with insulin for 6 mo with improvement in glycemic control, and the glucose-clamp studies repeated. Changes in glucose uptake at an insulin infusion rate of 1.0 mU X kg-1 X min-1 varied greatly from diagnosis to 6 mo. There were significant negative correlations between change in glucose uptake and diabetes type (r = -.78, P less than .002), C-peptide secretion (r = -.66, P less than .05), and age (r = -.62, P less than .05). At an insulin infusion rate of 10 mU X kg-1 X min-1 there was improvement in glucose uptake from diagnosis to 6 mo that did not reach statistical significance. During the steady-state periods of the glucose-clamp studies at diagnosis, growth hormone (GH) rose above basal, which reached statistical significance at the higher insulin infusion rate. This increase in GH was not apparent at the time of the glucose-clamp studies after insulin therapy. Our results indicate that in the clinical situation, only patients with IDDM can expect an improvement in their sensitivity to physiologic insulin levels with long-term insulin therapy. In all subjects, improvement in glycemic control leads to abolition of GH secretion in the presence of hyperglycemia.     

Comparison of an insulin analog,insulin aspart,and regular human insulin with no insulin in gestational diabetes mellitus

OBJECTIVE: To assess the short-term efficacy of insulin aspart in comparison with regular human insulin in women with gestational diabetes mellitus (GDM) during standardized meal tests. RESEARCH DESIGN AND METHODS: The study included 15 women with GDM who had inadequate diabetes control with diet alone. On 3 consecutive days, breakfast meal tests were performed-the first with no exogenous insulin and the other two after the injection of either regular insulin or insulin aspart. RESULTS: The peak insulin concentration was higher and the peak glucose and C-peptide concentrations were lower with both insulin preparations than with no exogenous insulin. Glucose areas under the curve above baseline were significantly lower with insulin aspart (180-min area, 7.1 mg. h. dl(-1); P = 0.018), but not with regular insulin (30.2 mg. h. dl(-1); P = 0.997), than with no insulin (29.4 mg. h. dl(-1)). CONCLUSIONS: This study demonstrates that effective postprandial glycemic control in women with GDM who required insulin was brought about by insulin aspart through higher insulin peak and lower demand on endogenous insulin secretion.     

Intensive insulin therapy with insulin lispro: a randomized trial of continuous subcutaneous insulin infusion versus multiple daily insulin injection

OBJECTIVE: To evaluate glycemic control, hypoglycemic events, and quality of life in patients treated with continuous subcutaneous insulin infusion (CSII) and multiple daily insulin injection (MDI), with insulin lispro as the principal insulin. RESEARCH DESIGN AND METHODS: This clinical trial enrolled 27 patients with type 1 diabetes. They were randomly assigned to CSII (n = 13) or MDI (n = 14) treatment regimens. Glycemic control (HbA(1c) level) was the primary outcome and was measured monthly for 9 months. Secondary outcomes were patient reports of hypoglycemic events (recorded monthly for 9 months) and quality of life assessed at 9 months using the Diabetes Quality of Life (DQOL) questionnaire. RESULTS: A significant decrease in HbA(1c) from baseline was shown for both groups. However, the overall treatment effect (CSII - MDI) for HbA(1c) was +0.08% (95% CI -0.23 to +0.39, P > 0.10). This was significantly less than the a priori limit of +/-0.5% (P = 0.004). The relative treatment effect ([CSII - MDI]/MDI) for the overall number of hypoglycemic events was +9% (95% CI -37 to +87, P > 0.10). There were no statistically significant differences between treatment groups for any of the DQOL subscales. CONCLUSIONS: No statistically significant differences in glycemic control, reported hypoglycemic events, or quality of life were found in this study. Furthermore, a clinically significant difference of more than +/-0.5% HbA(1c) between the two regimens can be confidently ruled out. We conclude that the choice of intensive insulin therapy should be a matter of patient preference, consistent with lifestyle.     

Human insulin

Human insulin may be advantageous for certain subsets of patients, such as those with gestational diabetes and those who need insulin only during stress or surgery. To date, there is no evidence to support the use of human insulin in diabetics who are doing well on older insulin preparations.