门冬胰岛素与人正规胰岛素对不规律进食老年2型糖尿病患者血糖影响的研究

目的：研究门冬胰岛素与人正规胰岛素对不规律进食老年2型糖尿病患者血糖的影响。方法：2006年2月至2007年4月老年2型糖尿病患者共33例男性18例，女性15例，平均年龄（65．82±2．85）岁]被纳入研究，先后用方案A和方案B治疗，各4个月。方案A：三餐前30min皮下注射人正规胰岛素＋睡前皮下注射人低精蛋白锌胰岛素；方案B：三餐后10～15min皮下注射门冬胰岛素＋睡前皮下注射人低精蛋白锌胰岛素。每周检测2次空腹血糖（FBG）和早、午、晚餐后2h血糖；并对患者低血糖发生次数及其严重程度、糖化血红蛋白（HbA1c）变化进行对比观察。结果：患者的FBG和早、午、晚餐后2h血糖，在方案A治疗期间分别为（7．37±4．22）mmol／L、（9．73±3．38）mmol／L、（10．23±3．96）mmol／L和（10．85±3．36）mmol／L，在方案B治疗期间分别为（7．01±1．74）mmol／L、（9．23±1．58）mmol／L、（9．22±1．28）mmol／L和（9．76±1．32）mmol／L，差异有统计学意义（均P〈0．01）；方案B较方案A的餐后血糖波动幅度明显降低；治疗前后HbA1c的差值在方案A、B分别为（3．08±0．96）％和（3．37±0．47）％（P〈0．01）；低血糖发生次数及中重度低血糖发生率，在方案A治疗中分别为68例次及36．7％，在方案B治疗中分别为21例次及19．05％，差异有统计学意义（P〈0．001）。结论：门冬胰岛素餐后皮下注射可有效降低老年2型糖尿病患者的血糖，减小餐后血糖波动幅度，减少低血糖的发作次数并降低其严重程度，对不规律进食的老年糖尿病患者安全有效。

Studies on effects of insulin aspart and human regular insulin on blood glucose in elderly type 2 diabetic patients with irregular food intake

Objective： To study the effects of insulin aspart and human regular insulin on blood glucose in elderly type 2 diabetic patients with irregular food intake. Methods： Thirty-three elderly patients with type 2 diabetes mellitus 18 men, 15 women, average age （65.82 ± 2.85 ） years ] were enrolled in a clinical study from February 2006 to April 2007. They initially received regimen A （ SC human regular insulin 30 minutes before each meal and SC human isophane insulin at bedtime for 4 months） , followed by regimen B （SC insulin aspart 10-15 minutes after meals and SC human isophane insulin at bedtime for 4 months）. The fasting and 2-hour postprandial （after breakfast, midday meal, and evening meal） blood glucose levels were measured twice a week. The frequency and severity of hypoglycemia as well as the changes in glycosylated haemoglobin （HbAlc） levels were observed comparatively between the two regimens. Results： The fasting and 2-hour postprandial （after breakfast, midday meal, and evening meal） blood glucose levels were （7.37±4.22） mmol/L, （9.73 ±3.38） mmol/L, （10.23±3.96） mmol/L, and （10.85 ±3.36） mmol/L for regimen A, and （7.01 ±1. 74） mmol/L, （9. 23 ± 1.58） mmol/L, （9. 22 ± 1. 28） mmol/L, and （9.76 ± 1. 32） mmol/L for regimen B, respectively. The differences were statistically significant （all P 〈0.01 ）. The fluctuations of postprandial blood glucose were lower for regimen B than for regimen A. The difference values of HbAlc before and after treatment was （ 3.08 ± 0.96） % for regimen A and （ 3.37 ± 0.47） % for regimen B （ P 〈 0.01 ） , respectively. The frequency of hypoglycemia and the incidence of moderate-to-severe hypoglycemia were 68 cases and 36.70% for regimen A, and 21 cases and 19.05% for regimen B, respectively. The differences were statistically significant （ P 〈 0. 001 ）. Conclusion ： In elderly type 2 diabetic patients, subcutaneous injection of insulin aspart after meals can effectively decrease th