初诊断2型糖尿病合并肝硬化的患者长效地特胰岛素治疗观察

目的 观察合并代偿期肝硬化初诊断的2型糖尿病患者应用长效地特胰岛素治疗的动态血糖特点.方法对合并代偿期肝硬化的新诊断2型糖尿病患者30例,所有入选患者均未使用过降糖药物,糖化血红蛋白(HbA1c)在7%~10%范围内,无酗酒史,4周内无糖尿病急性并发症及急性合并症,心功能、肾功能正常,肝硬化组患者在患病前均无明确的糖尿病病史,排除合并丙型肝炎病毒抗体阳性或酒精性肝病者及其他肝炎患者.随机分为两组,均给予糖尿病饮食及运动指导,治疗组应用一日三餐前正规胰岛素联合晚上22:00长效地特胰岛素治疗,治疗30 d,对照组进行一日三餐前正规胰岛素联合晚上22:00精蛋白锌胰岛素治疗,治疗30 d.观察血糖、BMI、胰岛素用量、糖化血红蛋白.结果 两组血糖、糖化血红蛋白均有下降,但治疗组下降明显,体重指数治疗组下降稍明显,治疗组部分患者停用胰岛素,通过生活干预使血糖稳定,无严重低血糖事件.结论 代偿期肝硬化可导致2型糖尿病患者血糖波动更为明显,应用长效地特胰岛素治疗合并代偿期肝硬化的2型糖尿病使其其血糖波动明显减少.可获得良好血糖控制,改善胰岛功能,减轻胰岛素抵抗,取得良好疗效,是安全有效、符合生理需要的治疗措施.

The observation of insnlin detemir treatment of early diagnosis of type 2 diabetes and cirrhosis

Objective To observe compensatory cirrhosis merger of early diagnosis in patients with type 2 diabetes long-acting insulin detemir application of the dynamic characteristics of glucose treatment. Methods Merger of the compensatory cirrhosis new diagnosis of 30 cases of patients with type 2 diabetes, and in all pa- tients were not used oral glucose-lowering drugs, glycated hemoglobin （HbAlc） in the range of 7% - 10% in- side, no history of alcoholism, 4 weeks without diabetes complications and acute acute complications, the heart and kidney function is normal, in patients with liver cirrhosis group were no clear before sicken history of diabe- tes, eliminate the merger hepatitis c virus antibody positive or the alcoholic liver disease and other patients with hepatitis. Randomly divided into two groups, all give diabetes diet and exercise guide, the treatment group ap- plication three meals a day before the regular insulin joint night long-term 22：00 insulin detemir treatment, the treatment 30 days, and the control group for three meals a day before the regular insulin joint night 22：00 of lean protein zinc insulin therapy, the treatment of 30 days. Observe the glucose, BMI, insulin, dosage of glyco- sylated hemoglobin. Results Two groups of glucose and glycated hemoglobin decreased, but the treatment group down significantly, Body mass index dropped slightly in treetment. The treatment group patients to stop taking part of insulin, through intervention brought life glucose stable, no seere hypoglycemia events. Conclu- sion Compensatory cirrhosis may lead to the conclusion of type 2 diabetes glucose fluctuations is more appar- ent, long-term application insulin detemir compensatory cirrhosis of the merger of treatment for type 2 diabetes make it fluctuates significantly reduce their glucose levels. To receive a good blood glucose control, improving islet function, reduce insulin resistance, has achieved good effect, it was safe and effective, accord with physi- cal needs treatment measures.