半夏泻心汤联合甘精胰岛素注射液对脾弱胃强型2型糖尿病患者血糖及免疫指标的影响

目的考察半夏泻心汤联合甘精胰岛素注射液对脾弱胃强型2型糖尿病患者血糖及免疫指标的影响。方法选取2019年1月～2020年12月于天津市河西区康复医院诊治的脾弱胃强型2型糖尿病患者120例,随机分为对照组和观察组,每组60例,对照组仅给予甘精胰岛素注射液,观察组给予半夏泻心汤联合甘精胰岛素注射液。比较两组治疗后1个月和3个月患者临床治疗有效率,治疗前、治疗后1个月和3个月糖化血红蛋白(glycosylated hemoglobin,HbA1c)和空腹血糖(fasting plasma glucose,FPG)及免疫细胞CD3⁺、CD4⁺、CD8⁺和CD4⁺/CD8⁺水平。结果相比于对照组,观察组治疗后1个月和3个月临床治疗有效率显著提高(P <0.05);两组治疗前血糖和免疫相关指标相比,差异无统计学意义(P>0.05),治疗后1个月和3个月,两组患者HbA1c、FPG和CD8⁺相比于治疗前均显著降低,而CD3⁺、CD4     

双时相门冬胰岛素联用二甲双胍治疗2型糖尿病的成本-效果分析

目的:利用经济学模型,评价应用基础胰岛素治疗的中国2型糖尿病(T2DM)患者转换为双时相门冬胰岛素30(BIAsp30)联用二甲双胍治疗的长期经济与健康产出,证明BIAsp30的成本效果价值,旨在为临床医生和患者合理用药提供参考依据。方法:应用糖尿病CORE模型,计算患者长期(30年)的糖尿病治疗总成本、期望寿命和质量调整生命年。CORE模型是一项已发表的、经过验证和专家评审的、计算机模拟的糖尿病模型。293例中国T2DM患者的临床基线和治疗数据来自于一项16周、多中心和非随机无对照的用于评价基础胰岛素转用BIAsp30联合二甲双胍(MET)治疗的安全性与有效性的临床试验(NCT00614120)。其中基础胰岛素分为2个亚组,甘精胰岛素(IGla)联合MET组和中性鱼精蛋白锌胰岛素(NPH)联合MET组。药物和血糖检测的成本以市场价格计算,并发症及其管理成本是基于2008年已发表文献中的中国三级医院的糖尿病及其并发症成本数据进行CPI调整至2009年。本研究中的成本以直接医疗成本计算,包括降糖药物、血糖检测和糖尿病并发症的成本。直接医疗成本和质量调整生命年的年贴现率根据2006年中国药物经济学指南设定为3%。...     

重组甘精胰岛素联合阿卡波糖对新诊断的2型糖尿病患者β细胞功能改善的自身对照研究

目的研究重组甘精胰岛素+阿卡波糖运用于新诊断的2型糖尿病患者中的价值及对β细胞功能的影响。方法选择2015年7月～2018年5月我院新诊断的2型糖尿病患者103例作为研究对象,给予重组甘精胰岛素+阿卡波糖进行治疗,观察治疗结果及治疗前后β细胞功能改善情况。结果治疗后治疗达标99例(96.12%),其余4例治疗未达标(3.88%),治疗达标的平均甘精胰岛素使用量为(24.36±1.05)U/d,达标时间(8.14±2.60)d,随访中发现低血糖发生率为2.91%(3/103);治疗前后患者的BMI、TC水平相比无差异(P0.05),治疗后FBG、2hPG、糖化血红蛋白及TG水平均低于治疗前(P0.05);治疗后患者的HOMA-β、HOMA-IR、AUC_(0-10)及AIR_(1-3)水平均优于治疗前(P0.05);不良反应发生率为8.74%。结论重组甘精胰岛素+阿卡波糖运用于新诊断的2型糖尿病中效果明显,能够有效降低血糖水平,改善β细胞功能,控制病情,治疗后不良反应较少,安全性高,为预后提供保障。     

No evidence for accumulation of insulin glargine (LANTUS): a multiple injection study in patients with Type 1 diabetes.

AIMS: Insulin glargine is a long-acting insulin analogue that is metabolically active for at least 24 h. We investigated the multiple-dose pharmacokinetic properties of insulin glargine to determine whether daily injections lead to the accumulation of circulating insulin levels and a corresponding decrease in blood glucose levels in patients with Type 1 diabetes. METHODS: Fifteen patients using preprandial insulin lispro (mean age 36 +/- 9 years, body mass index 24.6 +/- 2.2 kg/m(2)) completed the study. Each patient's optimal insulin glargine dose was determined during a dose-finding phase. After a washout period, patients were treated over 12 days with a constant daily dose of insulin glargine injected in the abdominal subcutaneous adipose tissue at 22:00 h, and with preprandial insulin lispro. Free serum insulin (FSI) and blood glucose concentrations were assessed hourly after the first, fourth, and eleventh injection, after which patients fasted for 24 h and did not use any other insulin preparation. RESULTS: There were no changes in daily insulin doses during the dose-finding phase (insulin glargine: initial dose 24 +/- 6 IU, mean change 0 +/- 3 IU; insulin lispro: 18 +/- 9 IU, 0 +/- 7 IU). The time course of FSI was comparable on the three pharmacokinetic study days. Notably, the trough FSI at the end of the sampling periods was almost identical (day 1, 79 +/- 56 pmol/l, day 4, 77 +/- 56 pmol/l, day 11, 86 +/- 60 pmol/l). No changes occurred in any of the pharmacokinetic parameters studied. CONCLUSIONS: There is no evidence that insulin glargine accumulates after multiple injections over 12 days. These results indicate that the predetermined dose of insulin glargine will not need to be reduced after commencing treatment because of a risk of accumulation.     

Insulins NPH,glargine, and detemir,and risk of severe hypoglycemia among working-age adults*

Introduction: The longer acting basal insulin analogs glargine and detemir have shown a lower incidence of hypoglycemia compared to insulin NPH in clinical studies. We evaluated the real-life risk of severe hypoglycemia among new users of insulins in the working-age population in Finland.

Methods: All persons aged 18–65 years with diabetes mellitus who were newly prescribed with insulins NPH, glargine, or detemir during 2006–2009, were identified from national registers. Risk of severe hypoglycemia requiring hospital care was compared between insulin types.

Results: A total of 16,985 persons initiated basal insulin treatment (5586, 7499, and 3900 patients started NPH, glargine, and detemir, respectively) during follow-up. Five hundred and thirty-six persons were hospitalized because of severe hypoglycemia. Absolute rate (per 1000 patient-years) was 20.6 (95% CI 17.9, 23.8), 17.8 (15.6, 20.3), and 12.4 (9.9, 15.5) for NPH, glargine, and detemir initiators, respectively. With NPH as reference, the adjusted hazard ratio (HR) was 0.92 (95% CI 0.74, 1.15, p?=?0.47) for glargine, and 0.70 (0.51, 0.94, p=?0.018) for detemir. The HR for detemir compared to glargine was 0.76 (0.58, 0.99, p?=?0.040).

Conclusions: Initiating insulin treatment with detemir, but not with glargine, was associated with a significantly lower risk of severe hypoglycemia compared to NPH, among working-age adults.

• KEY MESSAGES

• The comparative safety of modern basal insulins regarding hypoglycemia among the working-age population is unclear.

• Large reductions in the incidence of severe hypoglycemia were seen among real-life patients who started insulin detemir, as compared to patients who initiated glargine or especially NPH insulin.

• Given the large amount of patients using insulin, these findings may have considerable clinical consequences at the population level.

     

Glargine Insulin Use Versus Continuous Regular Insulin in Diabetic Surgical Noncritically Ill Patients Receiving Parenteral Nutrition: Randomized Controlled Study

Background: Hyperglycemia is a major complication of parenteral nutrition (PN). Guidelines for hyperglycemia management in noncritically ill patients cite basal insulin administration but do not recommend a regimen. The GLUCOSE‐in‐PN study aimed to compare the efficacy of glargine insulin versus continuously infused regular insulin in PN (RI‐in‐PN) to achieve glycemic control in noncritically ill surgical patients with diabetes who were receiving PN. Methods: This prospective randomized open‐label study was conducted at King Faisal Specialist Hospital and Research Centre. Noncritically ill surgical patients with diabetes who were receiving PN were randomized to receive basal glargine insulin or RI‐in‐PN on day 4 of PN support. Mean blood glucose levels were compared on study days 5–9. The percentages of blood glucose measurements at goal were compared between groups. Results: Sixty‐seven PN treatment episodes were analyzed. There were no statistically significant differences in mean glucose levels between groups on any study day (P > .1). Overall glycemic control rates were 52.24% (glargine insulin) and 47.76% (RI‐in‐PN; P = .06). A significantly higher percentage of hyperglycemia was observed on day 5 for glargine insulin versus RI‐in‐PN (22.39% vs 5.97%, P = .0059). Blood glucose measurements indicated 6 hypoglycemic events: 2 for glargine insulin (5.7%) and 4 for RI‐in‐PN (11.4%; P > .1). Conclusion: Both glargine insulin and RI‐in‐PN are effective basal insulin modalities for blood glucose control in noncritically ill surgical patients with diabetes who are receiving PN. Uncontrolled hyperglycemic events occurred more frequently with glargine insulin, and the rate of hypoglycemia was acceptable for both regimens.     

糖尿病患者起始胰岛素治疗方案的选择及安全性评价

【摘要】目的 探讨口服二甲双胍控糖效果不佳糖尿病患者起始胰岛素治疗方案的选择及安全性。方法 选取口服二甲双胍控糖效果不佳的2型糖尿病患者126例随机分为3组,在二甲双胍治疗基础上,分别联用西格列汀、起始剂量10 U/d胰岛素、起始剂量15 U/d胰岛素分别作为A组、B组、C组,治疗期间均根据血糖控制情况调整用药剂量,达到并维持空腹血糖≤56 mmol/L。记录3组血糖达标率、达标时间、低血糖反应;计算治疗前后体重指数(BMI)、体重差值,统计三组治疗前后空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋(HbA1c)、胰岛素抵抗指数(HOMA IR)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL C)。结果〓本研究中A组5例脱落,B组7例脱落,C组8例脱落。3组患者血糖达标率、低血糖反应发生率比较差异无统计学意义(P＞005);C组血糖达标时间短于A组、B组(P＜005),但A组、B组比较差异无统计学意义(P＞005)。3组治疗后FPG、2hPG、HbA1c、HOMA IR均下降,FINS上升,同组治疗前后差异有统计学意义(P＜005),但3组组间比较差异无统计学意义(P＞005)。A组治疗前后BMI、体重差值低于B组、C组,差异有统计学意义(P＜005),但B组、C组比较差异无统计学意义(P＞005)。结论〓口服二甲双胍控糖效果不佳2型糖尿病患者联合西格列汀、甘精胰岛素均可获得理想的降糖效果,且加大基础甘精胰岛素方案起始用药剂量可缩短血糖达标时间,但西格列汀在控制体重上更具优势。     

甘精胰岛素联合瑞格列奈治疗2型糖尿病临床疗效观察

目的探讨甘精胰岛素联合瑞格列奈治疗2型糖尿病的治疗效果。方法选择我院2016年3月~2017年6月间收治的2型糖尿病患者72例作为研究对象,按照电脑随机数分组的方案,将其随机分为两组,分别为对照组和实验组,每组36例患者。对照组患者采用单纯预混胰岛素进行治疗,而实验组患者则应用甘精胰岛素联合瑞格列奈进行治疗。对比两组患者的治疗效果,记录两组患者的空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)的数值,分析治疗效果。结果实验结果显示,实验组患者的治疗总有效率较对照组明显更高,差异具有统计学意义(P0.05)。两组患者在治疗完成后,各项指标数据均有所改善,但实验组患者改善程度较对照组明显更优,差异具有统计学意义(P0.05)。结论应用甘精胰岛素联合瑞格列奈对2型糖尿病患者进行治疗能够有效提高患者的治疗效果,缓解患者的临床症状,控制患者的各项血糖指标水平,具有较好的治疗效果,值得在临床上推广使用。     

The effects of insulin glargine treatment and an educational programme on glycaemic control in type 2 diabetes patients in clinical practice

ABSTRACT

Objective: This retrospective analysis was performed to establish the effect of initiating insulin glargine (LANTUS; sanofi-aventis, Paris, France), a once-daily basal insulin analogue, in combination with an educational programme on glycaemic control and body weight in sub-optimally controlled patients with Type 2 diabetes in clinical practice.

Research design and methods: We undertook a retrospective review of the medical records of 46 patients (mean age 61.5 ± 8.6 years) with Type 2 diabetes. These patients had previously been treated with oral antidiabetic agents (OADs; n = 18) or insulin only (n = 28) and had then received insulin glargine in combination with OADs or prandial insulin, for 30 months. Records of metabolic control and body weight data were analysed at 9 and 30 months. Patients had taken part in a diabetes educational programme before initiation of insulin glargine and received continued physician consultations throughout.

Results: Following initiation of insulin glargine, patients showed a significant decrease in HbA_1c from 8.14 ± 1.7% to 7.18 ± 0.9% at 30 months (?p < 0.001). When the results were analysed by pre-treatment, patients pre-treated with OADs showed a reduction in HbA_1c of 2.3% at 30 months (?p < 0.001), while patients pre-treated with insulin only showed a decrease in HbA_1c of 0.4% (?p < 0.005). There was no significant change in body weight. No unexpected adverse events or episodes of severe hypoglycaemia (blood glucose < 40?mg/dL [< 2.2?mmol/L]) occurred.

Conclusions: Insulin glargine in combination with educational support and close clinical supervision significantly improved metabolic control without significant weight change in patients with Type 2 diabetes in clinical practice over 30 months. Additional studies are required to establish if similar results can be obtained in a larger cohort of patients.