合并感染的2型糖尿病患者胰岛素泵的临床应用

目的 比较连续皮下胰岛素注射(CSII)在伴和不伴感染的2型糖尿病(T2DM)患者中的应用。 方法 CSII感染组96例、CSII非感染组95例,均进行短期胰岛素强化治疗,比较两组血糖水平、血糖达标时间、单位体重胰岛素用量、低血糖发生率等,同时对伴和不伴感染的T2DM病人CSII应用方法进行比较。 结果 CSII感染组血糖达标时间为6.81±2.64天,非感染组为5.83±2.49天,CSII感染组达标时间较长(P＜0.05),且胰岛素用量较非感染组增加了约13%;感染组的CSII应用中主要是基础率水平较高;影响血糖达标和胰岛素用量的主要因素是感染、血糖水平和体质指数。 结论 CSII在合并感染的T2DM患者中能有效控制血糖,但胰岛素需要量增加,可通过增加凌晨和白天段的基础率来达到理想的血糖控制。     

胰岛素泵在2型糖尿病合并肺结核患者血糖控制中的应用与护理

目的观察检测胰岛素泵在2型糖尿病合并肺结核患者血糖控制中的护理措施与效果。方法抽取该院自2013年1月—2014年6月收治的110例2型糖尿病合并肺结核患者,随机分为对照组和观察组两组,对照组采用多次皮下注射胰岛素方式,观察组采用胰岛素泵治疗方法,对比两组患者的血糖控制情况。结果经过两组对比,观察组患者血糖控制情况优于对照组,两组相比差异有统计学意义P0.05。结论对2型糖尿病患者使用胰岛素泵治疗可以明显改善患者病情,能更好的控制血糖,减缓症状,促进结核灶愈合。     

胰岛素泵治疗肺结核合并2型糖尿病的临床疗效

目的探讨胰岛素泵治疗肺结核合并糖尿病患者的临床效果。方法将初治菌阳空洞性肺结核合并2型糖尿病患者随机分为持续皮下胰岛素输注组(CSII组)、多次皮下胰岛素注射组(MSII组)、口服降糖药物治疗组(OAD组),比较观察三组患者治疗前及治疗2个月后血糖控制情况、痰菌转阴率、病灶吸收有效率、空洞闭合率等方面的差异。结果 CSII组、MSII组在血糖控制、痰菌转阴率、病灶吸收有效率、空洞闭合率均显著高于OAD组,CSII组胰岛素用量、血糖达标时间显著优于MSII组。结论胰岛素泵治疗肺结核合并糖尿病,在平稳有效安全降糖的同时更有利于促进痰菌转阴。     

胰岛素泵治疗2型糖尿病合并妊娠患者的疗效分析

目的分析胰岛素泵治疗2型糖尿病合并妊娠患者的疗效。方法选择2018年2月—2019年1月在该院接受治疗的56例2型糖尿病合并妊娠患者,随机分为观察组和对照组,其中观察组患者选择胰岛素泵治疗,对照组患者采取传统的多次皮下注射方式进行治疗。经过治疗干预后比较两组患者的血糖情况、体质量指数、并发症情况及妊娠结局。结果经过治疗干预,观察组患者的空腹血糖含量为(5.17±0.68)mmol/L,并发症发生率为17.85%,体质量指数为(21.22±2.03)kg/m2,对照组患者的空腹血糖含量为(5.62±0.98)mmol/L,并发症发生率为32.14%,体质量指数为(24.78±2.04)kg/m2。且统计结果显示,观察组患者的妊娠结局要在一定程度上优于对照组。结论采取胰岛素泵治疗2型糖尿病合并妊娠可以取得较好的治疗效果,且有助于降低患者并发症的发生率,改善患者妊娠结局。     

胰岛素泵在2型糖尿病中的应用

2004年3月～2005年2月,我们对60例2型糖尿病患者分别采用胰岛素泵持续皮下输注（CSⅡ）和胰岛素多次皮下注射（MSⅡ）治疗,并进行疗效比较.现报告如下.     

胰岛素泵在不同体质指数的2型糖尿病患者中的应用

对肥胖与非肥胖的2型糖尿病（T2DM）患者行连续皮下胰岛素注射（CSII）治疗,发现肥胖组血糖达标时胰岛素用量（0．70±0．15U·kg^-1·d^-1）较非肥胖组（0．61±0．23U·kg^-1·d^-1）明显增加（P〈0．01）,胰岛素用量与体质指数和腰臀比有明显的正相关性。     

胰岛素泵在2型糖尿病血糖控制中的应用与护理

目的探讨胰岛素泵在2型糖尿病控制中的应用方法与护理效果。方法抽取该院自2013年1月—2014年1月收治的120例2型糖尿病患者,随机分为对照组和观察组两组,对照组采用多次皮下注射胰岛素方式,观察组采用胰岛素泵治疗方法,对比两组患者的血糖控制情况。结果经过两组对比,观察组患者血糖控制情况优于对照组,且住院时间也减少。结论对2型糖尿病患者使用胰岛素泵治疗可以明显改善患者病情,能更好的控制患者血糖情况,减少住院时间,值得推广应用。     

胰岛素泵治疗2型糖尿病的临床研究

2型糖尿病患者136例，随机分成2组，持续皮下胰岛素输注（CSⅡ）组68例，采用胰岛素泵连续皮下注射短效胰岛素。30R组患者68例，采用每日二次（早晚餐前半小时）皮下注射预混胰岛素（Novolin 30R）。结果：两组均能有效控制血糖达到较好水平，CSⅡ组需要的达标血糖时间，胰岛素用量及低血糖发生率明显减少。结论：胰岛素泵强化治疗能较好的模拟胰岛素分泌的生理节律，更能有效控制高血糖，减少血糖波动和低血糖的发生。     

持续胰岛素泵注射在2型糖尿病合并乳腺癌患者化疗中的应用效果

目的 探究在2型糖尿病合并乳腺癌患者化疗过程中将持续胰岛素泵注射方法进行应用对患者治疗效果的影响情况。方法 选择2018年2月—2021年11月100例2型糖尿病患者合并乳腺癌患者,患者接受化疗干预。将患者分为两组,每组50例,分别给予二甲双胍常规控糖干预和持续胰岛素泵注射干预,对两组患者治疗前后的血糖指标、治疗恢复指标和不良反应发生率进行比较。结果 治疗前,两组各项血糖值均较高,差异无统计学意义(P>0.05),治疗后,两组患者的各项血糖值降低,研究组空腹血糖、餐后2 h血糖和糖化血红蛋白分别为(6.57±0.27)mmol/L、(9.07±1.23)mmol/L和(6.56±0.56)%,均比对照组低,差异有统计学意义(t=7.527、3.588、6.429,P<0.05)。研究组血糖达标时间、住院时间分别为(3.42±0.65)、(33.45±2.34)d,比对照组更短,差异有统计学意义(t=14.468、4.143,P<0.05)。研究组不良反应发生率6.00%比对照组更低,差异有统计学意义(χ²=6.353,P<0.05)。结论 ...     

住院2型糖尿病患者胰岛素泵的合理应用

目的 探讨短期胰岛素泵强化治疗对2型糖尿病住院患者的应用方法,分析影响疗效及胰岛素用量的相关因素.方法 对1 276例2型糖尿病患者行胰岛素泵强化治疗,观察总体胰岛素泵应用情况,在初诊、老年伴肥胖或感染等特殊情况下胰岛素泵应用上的差别.结果 胰岛素强化治疗后总体血糖在(5.7±2.6)d达标,达标时单位胰岛素用量为(0.69±0.31)U·kg-1·d-1;初诊组达标较快,达标后胰岛素减量更早,幅度更大,达到临床缓解的比例更高;老年组夜间基础率较低,且夜间低血糖发生的风险较大;伴肥胖组餐前胰岛素用量较大,但低血糖风险较低;伴感染组胰岛素用量较大,主要是基础率明显增加;血糖达标天数和胰岛素用量主要与感染、基础血糖及肥胖显著相关.结论 对不同人群的连续皮下胰岛素输注应用方法存在着差别,患者的感染、基础血糖和肥胖指标有助于确定初始胰岛素用量.     

胰岛素泵治疗2型糖尿病合并社区获得性肺炎的研究

目的 观察胰岛素泵持续皮下注射(CSII)与多次皮下胰岛素注射(MDI)治疗2型糖尿病合并社区获得性肺炎(CAP)患者的疗效.方法 将2004年12月-2008年12月在我院住院的2型糖尿病合并CAP患者104例随即分为两组:CSII组和MDI组,各52例,观察两组血糖达标时间,胰岛素用量、低血糖发生次数、肺炎控制时间及住院花费.结果 CSII组和MDI组患者血糖达标时间((5.6 ±1.6)d和(7.7±2.4)d],胰岛素用量[(36.9±11.5)U/d和(48.1±12.6)U/d),治疗第5天、第10天肺炎治疗有效率(50.9%和36.7%、77.3%和62.4%),平均住院天数[(15.6±2.6)d和(19.1 ±2.2)d],平均住院花费[(7635±633)元和(8248±748)元],差异均有统计学意义(P<0.05),低血糖发生次数分别为4例6次和6例9次,差异无统计学意义.结论 CSII配合抗生素治疗能快速控制2型糖尿病合并CAP患者的血糖水平及肺炎症状,减少胰岛素用量、平均住院天数及住院花费,是理想的治疗方法 .     

Insulin Pump Therapy in Childhood Diabetes Mellitus

The current goals for the therapy of children and adolescents with type 1 diabetes mellitus are to achieve near-normal glycemia, minimize the risk of severe hypoglycemia, limit excessive weight gain while achieving adequate growth, improve quality of life for both the patients and their families, and delay or prevent vascular complications. Insulin pump therapy provides a treatment option that can significantly aid in achieving all of these goals across all age ranges of pediatric patients. Continuous subcutaneous insulin infusion (CSII) pump therapy can provide greater flexibility in the timing of meals and snacks, has programmable basal rates to optimize overnight glycemic control, can reduce the risk of exercise-induced hypoglycemia, and enhances the ability of the patient and the family members to achieve acceptable diabetes control. In pediatric patients, CSII has been shown to reduce both glycosylated hemoglobin levels and the frequency of severe hypoglycemia without increasing the risk of diabetic ketoacidosis. The effectiveness of CSII, improvements in pump technology, and the availability of very rapid-acting insulin analogs have fueled a dramatic increase in the use of this therapy. This review presents practical guidelines for the selection of patients, initiation of treatment and patient education, as well as guidelines for use while exercising and at school. Keys to the success of CSII are to have a multidisciplinary team of clinicians who are expert in the care of children with diabetes, and patients and families who are able to carry out the tasks of intensive treatment, including self-monitoring of blood glucose levels, carbohydrate counting, and infusion pump management. Patients and parents need to be able to recognize and treat hypoglycemia, and prevent the development of ketoacidosis. School personnel need to be involved in the treatment plan and individual algorithms developed for periods of extra exercise and activity. The recent introduction of methods for continuous glucose monitoring provides a new means to optimize the basal and bolus capabilities of CSII and offers hope for the development of a feedback-controlled artificial pancreas.     

长期2型糖尿病患者多次胰岛素泵强化治疗多次缓解病例报告1例

目的报告对1例长病程2型糖尿病患者经胰岛素泵治疗后缓解的情况,并复习国内外相关资料,以加深对2型糖尿病患者强化治疗后得到缓解的患者的特点的认识,以选择更多有适应证的患者进行强化治疗。方法对1例长病程2型糖尿病患者多次强化治疗得到缓解的经过进行分析并复习相关文献。结果该患者有11年糖尿病病史,分别通过3次为期2周的胰岛素泵强化治疗,期间有长达5~6年的缓解期。此次患者拆泵后观察,患者血糖控制良好。结论对初治的2型糖尿病患者,胰岛素泵治疗能更快更好的使血糖得到控制,使胰岛细胞功能得到恢复,并在一段时间内结合运动和饮食治疗,不需要药物控制血糖的一种好方法。     

Long-term Efficacy of Insulin Pump Therapy in Children with Type 1 Diabetes Mellitus

Objective: Insulin pumps have been well established for insulin delivery. However, questions about long-term efficacy of insulin pump therapy still remain. We evaluated the long-term efficacy of continuous insulin infusion pump therapy (CSII) in pediatric patients with type 1 diabetes mellitus (T1DM).Methods: This was a retrospective observational study which included 131 patients with T1DM who transitioned to an insulin pump from multiple daily insulin (MDI) injections between 1999 and 2009 and were followed by one endocrinologist. Data were collected from 6 months prior to switching to CSII to 30 months after initiation of CSII and included glycated hemoglobin (HbA1c) and insulin requirement. Of the 131 patients, 45 had complete data consisting of a visit and HbA1c every 6 months for 30 months after transition to CSII and were included for analysis. Results: Mean HbA1c prior to starting the CSII was 8.0 +0.9 %, 7.7 +1.0 % at 6 months and 7.8+1.2 % at 1 yr post initiation of CSII. However, at 30 months, HbA1c increased to 8.0+1.3%. A trend in transient improvement in HbA1c was limited only to those patients >11 yr of age and those requiring >0.75 u/kg/day of insulin at transition and was not seen in those <11 yr of age or those requiring <0.75 u/kg/day and did not persist beyond 1 year. Conclusions: There was no long-term significant difference in glycemic control in patients with CSII as compared to MDI. Conflict of interest:None declared.     

严重脓毒症合并高血糖的强化胰岛素治疗

目的:探讨强化胰岛素治疗方案对严重脓毒症患者预后的影响。方法:将102例严重脓毒症呼吸衰竭并高血糖患者随机分为强化胰岛素治疗组(将随机血糖控制在4.4~6.1mmol/L之间)和常规治疗组(当随机血糖超过12mmol/L开始应用胰岛素,将血糖控制在10~11.1mmol/L之间)。观察ICU病死率、住院病死率、ICU住院天数、总住院天数、呼吸机治疗时间和继发肝、肾功能异常情况。结果:与常规治疗组比较,强化胰岛素治疗组的ICU住院天数、总住院天数和呼吸机治疗时间均明显缩短(P<0.01),继发性肾损害减少(P<0.05),ICU病死率和住院病死率虽然均有降低,但无统计学意义(P>0.05)。结论:强化胰岛素治疗可以减少严重脓毒症并发高血糖患者的ICU住院时间和总住院时间,缩短呼吸机带机时间,降低继发性肾损害的发生率。     

Achieving Glycemic Goals With Addition of Incretin-based Therapies to Insulin in Patients With Type 2 Diabetes Mellitus

As type 2 diabetes mellitus progresses, multiple antihyperglycemic agents are needed to maintain adequate glycemic control. Consensus guidelines recommend combining agents with complementary mechanisms of action. Given that hypoglycemic events increase the risk of cardiovascular disease and that weight gain affects mortality in obese individuals, it is important to control hyperglycemia without inducing hypoglycemia or weight gain. Peer-reviewed clinical trial data from patients requiring insulin-containing combination therapy suggest that insulin may be more effective at controlling hyperglycemia when given with appropriate combination therapy, but insulin is associated with weight gain and hypoglycemia. Some agents should not be combined with insulin because of associated weight gain and edema (ie, thiazolidinediones) or hypoglycemia (ie, sulfonylureas). Conversely, the lack of weight gain and hypoglycemia associated with metformin, glucagon-like peptide-1 agonists and dipeptidyl peptidase-4 inhibitors and suppression of glucagon secretion by both classes of incretin-based therapies suggest that these agents are well suited to combination therapy with insulin.     

V-Go Insulin Delivery System Versus Multiple Daily Insulin Injections for Patients With Uncontrolled Type 2 Diabetes Mellitus

Type 2 diabetes mellitus affects over 29.1 million Americans, diagnosed and undiagnosed. Achieving and maintaining glycemic control for these patients is of extreme importance when working to prevent complications and improve quality of life for patients. The V-Go is a newly developed insulin delivery system. The push of a button inserts a needle into the patient once daily and remains attached for 24 hours. The V-Go is designed to release a set basal rate throughout the day, while allowing patients to provide up to 36 units of on-demand bolus insulin with the manual click of 2 buttons. It is a spring-loaded device filled daily with rapid-acting insulin that runs without the use of batteries or computer software. The main objective of this prospective active comparator study was to observe the A1C lowering effects of multiple daily insulin injections (MDII) versus the use of the V-Go insulin delivery system for patients with uncontrolled type 2 diabetes mellitus over a 3-month period. In addition, the effect on insulin requirement for these patients was assessed with secondary comparisons of weight, blood pressure, prevalence of hypoglycemic events, and quality of life before and after 3 months of intensified insulin therapy with regular monitoring by a clinical pharmacist at an internal medicine clinic. The average A1C lowering experienced by the 3 patients in the V-Go group was 1.5%, while the average A1C change in the 3 patients in the MDII group was an increase of 0.2%. All patients in the V-Go group experienced a decrease in insulin total daily dose (TDD), with an average decrease of 26.3 units. All patients in the MDII group experienced an increase in insulin TDD with an average of 15 units daily to achieve therapeutic goals individualized for each patient. All patients who underwent intensification of insulin therapy experienced an increase in subjective quality of life (QOL) as determined using the Diabetes-39 (D-39) questionnaire, though QOL results lacked statistical significance.     

2型糖尿病并细菌性肝脓肿48例临床分析

糖尿病合并细菌性肝脓肿是糖尿病的严重并发症,如未早期诊断和及时治疗,可能发生全身迁徙性感染灶,如肺脓肿、脑脓肿等,并引发感染中毒症、感染性休克、DIC等,严重者可导致死亡。现对我院收治的48例2型糖尿病并细菌性肝脓肿的临床资料回顾分析如下。     

Spotlight on Insulin Aspart in Type 1 and 2 Diabetes Mellitus

Insulin aspart (NovoLog, NovoRapid), a rapid-acting human insulin analog, provides more rapid absorption than regular human insulin after subcutaneous administration. In most randomized, nonblind clinical trials in patients with type 1 diabetes mellitus, insulin aspart administered immediately before meals resulted in significantly lower mean glycosylated hemoglobin (HbA1c) levels than regular human insulin (usually administered 30 minutes before a meal). Insulin aspart also significantly improved postprandial glycemic control compared with regular human insulin. The efficacy of insulin aspart was similar to that of insulin lispro when administered to patients with type 1 diabetes mellitus via continuous subcutaneous infusion in a randomized, nonblind trial. Preliminary data from randomized, nonblind trials suggest insulin aspart had a trend towards lower HbA1c levels compared with regular human insulin in patients with type 2,diabetes mellitus. Biphasic insulin aspart (30% soluble [rapid-acting] and 70% protamine-bound insulin aspart [BIAsp30]) [NovoLog Mix 70/30, NovoMix 30(2)] generally provided significantly better postprandial glucose control than a similar mixture of biphasic regular human insulin (BHI30) in a randomized, nonblind trial in patients with type 1 or 2 diabetes mellitus. However, the long-term efficacy of BIAsp30 was similar to that of BHI30 after 2 years in a randomized, nonblind trial in patients with type 2 diabetes mellitus. Patients with type 1 or 2 diabetes mellitus reported greater treatment satisfaction with insulin aspart or BIAsp30 than with regular human insulin or BHI30. The overall incidence of hypoglycemia with insulin aspart was lower than, or similar to, that of regular human insulin. Moreover, insulin aspart tended to be associated with a lower occurrence of nocturnal hypoglycemia and severe hypoglycemic events than regular human insulin. Conclusion: The standard preparation of insulin aspart has the potential to better mimic the physiological response to meals than regular human insulin. Insulin aspart when combined with a suitable basal insulin improved overall glycemic control and led to a similar or lower number of hypoglycemic episodes compared with a similar regular human insulin regimen. Insulin aspart was generally as effective and well tolerated as insulin lispro when administered by continuous subcutaneous infusion in a single comparative trial. The efficacy of biphasic insulin aspart has been documented in a small number of trials. Both insulin aspart and biphasic insulin aspart provide for flexible and convenient administration. Insulin aspart is now well established as an effective and convenient means of providing glycemic control which offers clinical and practical advantages over regular human insulin.