德谷胰岛素—治疗糖尿病的新选择

糖尿病需要长期的药物治疗和患者自我饮食运动调节。无论1型还是2型糖尿病,随着病程的发展,注射外源性胰岛素都是必须的治疗手段。胰岛素有低血糖风险,理想的胰岛素治疗应该在改善血糖控制的同时,降低低血糖的危险。德谷胰岛素是一种新型超长效基础胰岛素,皮下注射后,半衰期接近25 h,只需1次/d给药,且其在到达稳态时没有胰岛素累积现象,峰谷比较其他基础胰岛素低,因此,低血糖风险更低。本文对德谷胰岛素的研究现状进行综述。     

改良健康教育路径在胰岛素强化治疗2型糖尿病患者中的应用

目的分析改良健康教育路径在胰岛素强化治疗2型糖尿病患者中的应用效果。方法资料选自2012年12月~2013年12月在内蒙古医科大学附属医院确诊为2型糖尿病并接受胰岛素强化治疗患者112例,按照完全抽样法1∶1分成两组,56例对照组患者予常规健康教育路径护理,56例研究组患者予改良健康教育路径,分析两组患者的认知能力与血糖指标改善情况。结果干预后,研究组糖尿病、胰岛素注射知识评分[（79.68±14.71）、（15.48±2.61）分]均比对照组[（56.74±21.46）、（10.64±3.75）分]高,差异有高度统计学意义（P〈0.01）;研究组空腹血糖（FPG）、餐后2 h血糖（2 h PBG）与糖化血红蛋白（HbA1c）水平均显著低于干预前及干预后对照组,差异有高度统计学意义（P〈0.01）;研究组遵医行为评分为（13.85±2.47）分,比对照组[（8.35±1.68）分]高,血糖达标时间为（28.75±9.57）d,比对照组[（41.78±14.62）d]短,低血糖发生次数为（1.03±0.57）次,比对照组[（4.35±2.16）次]少,差异有高度统计学意义（P〈0.01）。结论 2型糖尿病胰岛素强化治疗应用改良健康教育路径的控糖效果显著,利于改善患者预后。     

Regular insulin,rather than rapid‐acting insulin,is a suitable choice for premeal bolus insulin in lean patients with type 2 diabetes mellitus

The aim of the present study was to compare the usefulness of premeal rapid‐acting and regular insulin in type 2 diabetes patients. A total of 56 type 2 diabetic patients were investigated during hospitalization. Premeal rapid‐acting insulin was applied instead of other medications. Premeal insulin was titrated to adjust premeal and bedtime blood glucose levels to 81–120 mg/dL. Premeal rapid‐acting insulin was changed to regular insulin just before a meal at the same dosage if the postmeal blood glucose level was lower than the premeal blood glucose level. A total of 15 patients changed to regular insulin, and 41 patients continued rapid‐acting insulin. The blood glucose level was comparable between these two groups. Body mass index was significantly lower in the patients using regular insulin. According to the multivariate logistic regression analysis, low body mass index was an independent variable accounting for the usefulness of regular insulin. Regular insulin, rather than rapid‐acting insulin, is a suitable choice for premeal insulin in lean type 2 diabetic patients.     

动态血糖检测评估诺和锐30与诺和灵30R治疗2型糖尿病的血糖波动和低血糖事件

目的 探讨预混门冬氨酸30(诺和锐30)与预混人胰岛素(诺和灵30 R)在治疗2型糖尿病患者中血糖事件波动和低血糖发生情况的差异.方法 将口服降糖药控制不佳的患者随机分为诺和锐30组与诺和灵30 R组,待指血糖达标后用动态血糖仪监测3d,观察两组血糖波动和低血糖事件发生情况.结果 两组患者平均指血糖和指血糖的最高、最低值比较,差异无统计学意义(P＞0.05),但是用连续血糖检测系统(CGMS)监测发现诺和锐30组血糖波动和低血糖事件比诺和灵30 R组明显减少,差异有统计学意义(P＜0.05).结论 在2型糖尿病患者中诺和锐30虽然控制血糖的能力与诺和灵30 R相当,但是具有更少的血糖波动和低血糖事件;因此,在2型糖尿病治疗中依然有一定的优势,值得推广应用.     

甘精胰岛素联合二甲双胍治疗2型糖尿病

目的在口服降糖药不能良好控制血糖情况下,加用每日1次甘精胰岛素(来得时)或中效胰岛素(诺和灵N)联合二甲双胍治疗,比较这两种方案的疗效和不良事件。方法40例口服降糖药控制不良的2型糖尿病患者随机分为来得时+二甲双胍组(A组)和诺和灵N+二甲双胍组(B组),每组各20例,共观察3个月。比较2组治疗后空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、胰岛素用量、低血糖出现次数及体重增加情况。结果A组FPG﹑2hPG﹑HbA1c水平及出现低血糖次数﹑体重增加值均低于B组(P<0.01),平均来得时使用剂量大于诺和灵N。结论口服降糖药疗效差的2型糖尿病患者应用来得时联合二甲双胍治疗,有更显著、安全的降糖效果。     

Comparing the accuracy of transcutaneous sensor and 90-day implantable glucose sensor

Background and aimsContinuous glucose monitoring improves glycemic control in diabetes. This study compared the accuracy of the Dexcom G5 Mobile (Dexcom, San Diego, CA) transcutaneous sensor (DG5) and the first version of Eversense (Senseonics,Inc., Germantown, MD) implantable sensor (EVS).Methods and resultsSubjects with type 1 diabetes (T1D) and using EVS wore simultaneously DG5 for seven days. At day 3, patients were admitted to a clinical research center (CRC) to receive breakfast with delayed and increased insulin bolus to induce glucose excursions. At CRC, venous glucose was monitored every 15 min (or 5 min during hypoglycemia) for 6 h by YSI 2300 STAT PLUS? glucose and lactate analyzer. At home patients were requested to perform 4 fingerstick glucose measurements per day.Eleven patients (9 males, age 47.4 ± 11.3 years, M±SD) were enrolled. During home-stay the median [25th-75th percentile] absolute relative difference (ARD) over all CGM-fingerstick matched-pairs was 11.64% [5.38–20.65]% for the DG5 and 10.75% [5.15–19.74]% for the EVS (p-value = 0.58). At CRC, considering all the CGM-YSI matched-pairs, the DG5 showed overall smaller median ARD than EVS, 7.91% [4.14–14.30]% vs 11.4% [5.04–18.54]% (p-value<0.001). Considering accuracy during blood glucose swings, DG5 performed better than EVS when glucose rate-of-change was ?0.5 to ?1.5 mg/dL/min, with median ARD of 7.34% [3.71–12.76]% vs 13.59% [4.53–20.78]% (p-value<0.001), and for rate-of-change < -1.5 mg/dl/min, with median ARD of 5.23% [2.09–15.29]% vs 12.73% [4.14–20.82]% (p-value = 0.02).ConclusionsDG5 was more accurate than EVS at CRC, especially when glucose decreased. No differences were found at home.     

口服降糖药治疗失效的2型糖尿病患者使用地特胰岛素的安全性和有效性SOLVETM国际临床观察研究中国结果报道

 目的 诺和平1天1次注射研究（Study of Once-daily LeVEmir^®,SOLVE^TM）是一项为期24周、多中心、开放的观察性研究,旨在评价口服降糖药治疗失效的2型糖尿病患者中起始加用每天1次地特胰岛素（诺和平^®）治疗后的安全性和有效性。
方法 本研究来源于SOLVE^TM国际研究的中国结果。共有3272例使用口服降糖药治疗失效的2型糖尿病患者纳入本研究。参与研究的医生处方地特胰岛素,并在基线和治疗后12周、24周分别收集患者的临床数据,以评价药物的安全性和疗效。
结果 入选的3272例患者年龄（56.2±10.8）岁,糖尿病病程（7.1±5.2）年,基线BMI（25.3±3.3）kg/m²。治疗期间未观察到重度低血糖事件和夜间重度低血糖事件。治疗24周后,糖化血红蛋白（HbA1c）从基线的（8.33±1.69）%下降到（7.16±1.18）%,空腹血糖（FPG）从（9.52±2.59）mmol/L下降到（6.84±1.42）mmol/L,全天7个时点血糖全面改善,HbA1c<7％的患者达标率为49.1％。患者平均体重下降0.15 kg。
结论 口服降糖药失效的2型糖尿病患者,起始加用1天1次地特胰岛素治疗未观察到重度低血糖事件,同时有效改善血糖控制水平,提高治疗达标率,且对体重影响为中性。     

非降糖药引起的53例低血糖症不良反应分析

目的：了解非降糖药引起低血糖症不良反应,为临床合理用药提供参考。方法：采用《中国医院知识仓库》进行检索并查阅原始文献,对1994-2008年国内文献报道的非降糖药引起低血糖症不良反应进行汇总分析。结果：引起低血糖症不良反应的非降糖药主要是左旋门冬酰胺酶、加替沙星、萘普生,共占32.1%;原发疾病除感染外,以急性胰腺炎、白血病最为常见。结论：应关注非降糖药引起低血糖症不良反应,尤其是患有影响糖代谢疾病的患者。