口服降糖药联合地特胰岛素及餐前一次门冬胰岛素的治疗达标临床观察

目的观察2型糖尿病（T2DM）患者经口服降糖药联合地特胰岛素治疗仍未达标时，于餐前增加1次门冬胰岛素的有效性、安全性和可行性．方法采用自身治疗前后对照的方法．30例经口服降糖药联合地特胰岛素治疗而糖化血红蛋白（HbAlc）〉6．5％但〈9％的患者，于主餐前加用门冬胰岛素治疗12周．结果12周后，患者HbAlc由治疗前的（7．96-t-0．57）％降至（6．83±0．46）％（P〈0．001），其中7例（23．33％）达到≤6．5％，22例（73．33％）达到〈7．0％．不同餐前注射门冬胰岛素组餐后血糖均较前明显降低，HbAlc分别为（6．93±0．41）％、（6．84±0．35）％和（6．52±0．61）％．患者低血糖发生率低，无夜间低血糖和严重低血糖事件发生．患者平均体重及体重指数均明显下降．结论对于口服降糖药联合地特胰岛素治疗血糖控制欠佳的T2DM患者，于主餐前增加1次门冬胰岛素可以有效、安全地降低患者血糖，提高达标率，可减少体重增加，而且有较高的可行性．

Efficacy of the Addition of a Single Bolus of Insulin Aspart in Combination with Basal Insulin Detemir and Oral Antidiabetic Drugs

Objective To investigate the efficacy, safety and feasibility of the addition of a single bolus of insulin aspart before meal, in combination with basal insulin detemir and oral antidiabetic drugs （OADs） in the treatment of patients with type 2 diabetes. Methods 30 patients with type 2 diabetes who were suboptimally controlled （HbAlc6.5%-9.0%） on their previous detemir and OADs regimen were included in this 12 weeks , self-control study before and after treatment.A single injection of aspart was added , at main mealtime , to their existing therapy. Results HbAlc was decreased from （7.96± 0.57） % to （P〈0.001） .7 patients （23.33%） obtained the target of HbAlc ≤6.5%, （6.83± 0.46） %） after 12 weeks 22 patients （73.33%） obtained the target of HbAlc 〈7.0% .Aspart given at breakfast, lunch or dinner was equally effective in controlling plasma glucose level , and the HbAlc was （6.93 ± 0.41） % , （6.84 ± 0.35） % , （6.52 ± 0.61） % separately .The prevalence of hypoglycemia was lower, and no nocturnal hypoglycemia and serous hypoglycemia was reported .Body weight and body mass index were decreased compared with base line. Conclusion A single main mealtime bolus of aspart , added to detemir and OADs, is proved to be a practicable regimen which can significantly improve HbAlc levels and decrease body weight.