胰岛素剂量调整在接受胰岛素泵治疗的2型糖尿病患者血糖控制中的应用

目的：比较不同方法对应用胰岛素泵治疗的2型糖尿病患者血糖达标时间、血糖波动、低血糖发生和胰岛素用量等方面的影响，寻找胰岛素泵治疗2型糖尿病患者时使血糖安全、快速和有效达标的最佳方法。方法：选择应用预混胰岛素治疗血糖控制不佳住院的60例2型糖尿病患者，按照随机数字表法随机分为传统治疗组、大剂量向导组和大剂量向导联合监测组，每组20例。传统治疗组患者根据医生的经验及指尖血糖监测情况调整胰岛素剂量；大剂量向导组患者根据胰岛素泵自带大剂量向导软件及指尖血糖监测情况调整血糖；大剂量向导联合监测组患者同时联合大剂量向导软件及实时动态血糖监测系统（RTCGM）对患者进行血糖调整。检测患者指尖血糖水平，采用血糖水平的标准差（SDBG）和最大血糖波动幅度（LAGE）评价患者血糖波动情况。记录3组患者血糖达标时间、3d内SDBG和LAGE、低血糖发生情况及治疗后胰岛素用量。结果：大量剂向导组患者平均血糖达标时间少于传统治疗组（t=2.30，P<0.05），大剂量向导联合监测组患者平均血糖达标时间少于大剂量向导组（t=3.50，P<0.05）。治疗第3天，大剂量向导组患者SDBG和LAGE明显小于传统治疗组（t_SDBG=3.11，t_LAGE=2.54，P<0.05），大剂量向导联合监测组患者LAGE明显小于大剂量向导组（t_LAGE=2.47，P<0.05）。3组患者总体低血糖事件（χ²=2.192，P=0.532）、显著低血糖事件（χ²=2.765，P=0.322）和夜间低血糖事件（χ²=2.192，P=0.532）发生情况比较差异无统计学意义。3组患者平均胰岛素用量（F=2.102，P=0.131）、达标日非基础胰岛素用量（χ²=2.328，P=0.107）和非基础胰岛素百分比（χ²=2.104，P=0.131）组间比较差异无统计学意义。结论：大剂量向导软件联合RTCGM治疗2型糖尿病疗效较好，且不增加低血糖风险、不增加胰岛素用量。

Application of insulin dose adjustment in blood glucose control in patients with type 2 diabetes treated by insulin pump

Objective: To compare the effects of different methods on the glucose treat-to-target time,glucose fluctuation,hypoglycemia and insulin doses in the type 2 diabetic patients treated by insulin bump, and to find the best method to make the glucose to reach the standand level safely,fast and effectively in the type 2 diabetic patients treated by insulin bump.Methods: Sixty hospitalized type 2 diabetic patients inadequatly controlled by premix insulin treatment were randomly divided into convention group (n=20),Bolus Wizard group (n=20),and Bolus Wizard combined with monitoring(combination) group (n=20) according to the random number grouping method.The insulin doses of the patients in convention group were adjusted according to the glucose monitoring of fingertip and the doctor's experiences; the insulin doses of the patients in Bolus Wizard group were adjusted according to the Bolus Wizard software in insulin bump, and the glucose monitoring of fingertip; the insulin doses of the patients in combination group were adjusted according to the Bolus Wizard software combined with real time continuous glucose monitoring system(RTCGM). The level of fingertip glucose was tested.The standard deviation of blood glucose(SDBG)and largest amplitude of glycemic excursion(LAGE)were used to evaluate the glucose fluctuation of the patients in various groups. The treat-to-target time,glucose fluctuation,hypoglycemia and daily insulin doses of the patients in various groups were recorded.Results: Compared with convention group,the treat-to-target time of the patients in Bolus Wizard group was decreased(t=2.30,P<0.05);compared with Bolus Wizard group,the treat-to-target time of the patients in combination group was decreased(t=3.50,P<0.05).On the 3rd day of treatment, compared with convention group,the SDBG and LAGE of the patients in Bolus Wizard group were decreased(t_SDBG=3.11,t_LAGE=2.54,P<0.05); compared with Bolus Wizard group, the LAGE of the patients in combination group was decreased(t_LAGE=2.47,P<0.05).There were no significant differences in the incidence of total hypoglycemia events (χ²=2.192, P=0.532), significant hypoglycemia events (χ²=2.765, P=0.322) and nocturnal hypoglycemia events (χ²=2.192, P=0.532) among the patients in various groups; there were no significant differences in the average insulin dosage (F=2.102, P=0.131), the non-basic insulin dosage (χ²=2.328, P=0.107) and the percentage of non-basic insulin (χ²=2.104, P=0.131) among the patients in various groups.Conclusion: Bolus Wizard software combined with real-time dynamic RTCGM has better effect in the treatment of type 2 diabetes without increasing the risk of hypoglycemia and insulin dosage.