2型糖尿病患者胰岛素泵强化治疗后皮下注射胰岛素3种方式的疗效比较

目的观察比较2型糖尿病患者短期胰岛素泵(CSII)强化治疗血糖达标后改为皮下注射,分别转换成预混胰岛素70/30每天早晚餐前皮下注射,人胰岛素R及人胰岛素N 4次皮下注射及甘精胰岛素与门冬胰岛素4次皮下注射,观察血糖达标率,血糖控制情况及低血糖发生率。方法对本科2009年12月~2011年12月2型糖尿病患者CSII治疗7~10 d血糖达标者分为3组,预混胰岛素70/30每天2次早晚餐前皮下注射治疗组(A组),人胰岛素R及人胰岛素NPH四次皮下注射组(B组),甘精胰岛素与门冬胰岛素四次皮下注射组(C组),比较转换胰岛素治疗后3组的血糖达标率,低血糖发生率,日内血糖波动幅度。结果血糖达标率B组与C组差异无统计学意义,B组高于A组,C组高于A组;低血糖发生率C组低于A组(P<0.05),A组与B组差异无统计学意义,B组与C组差异无统计学意义,日内血糖波动3组之间差异无统计学意义。结论 3种治疗方式均能使血糖达标,可以获得相似的血糖控制状态,B组与C组治疗较A组血糖达标率高,低血糖发生率低,临床有较好的有效性及安全性。

Efficacy comparison of three modes of insulin injection after intensive therapy using a insulin pump in patients with type 2 diabetes

Objective To observe and compare the rate of blood glucose up to standard,levels of blood glucose control and incidence rate of hypoglycemia between daily multiple insulin injection and mixed insulin therapy in patients with type 2 diabetes(T2D) after short-term intensive therapy of continuous subcutaneous insulin infusion(CSII).Methods T2D patients received short-term intensive therapy of CSII to control blood glucose level.When the blood glucose level acquired good control after about 7-10 days,the patients were randomly divided into group A(premixed human insulin 70/30,subcutaneous injection,twice daily pre-breakfast and pre-dinner),group B(r-human insulin and NPH insulin,subcutaneous injection,q.i.d.) and group C(glargine and aspart,subcutaneous injection,q.i.d.).The conditions of blood glucose level including the rate of blood glucose up to standard,diurnal glucose fluctuation and incidence rate of hypoglycemia were compared between the 3 groups.Results There was no statistically significant difference in the rate of blood glucose up to standard between groups B and C,which was higher in groups B and C than in group A.The incidence rate of hypoglycemia was lower in group C than in group A(P<0.05),but the difference both between groups A and B and between groups B and C were statistically insignificant.The differences in the diurnal blood glucose fluctuations between the three groups were statistically insignificant.Conclusion All the three modes of treatment can make blood glucose reach standard level and obtain similar blood glucose control.Compared with group A,groups B and C has higher rates of blood glucose up to standard,lower incidence rate of hypoglycemia,better efficacy and safety.