速效胰岛素类似物和可溶性人胰岛素在初诊2型糖尿病胰岛素泵治疗中作用的比较

目的比较速效胰岛素类似物门冬胰岛素和中性可溶性人胰岛素在初诊2型糖尿病患者胰岛素泵强化治疗中的作用差异。方法59例初诊2型糖尿病患者,男35例,女24例,年龄51岁±12岁,体重指数25kg/m2±3kg/m2,随机使用速效胰岛素类似物门冬胰岛素(类似物组,30例)和中性可溶性人胰岛素(人胰岛素组,29例),进行2周的胰岛素泵治疗。比较两组治疗中空腹及餐后血糖下降速度、程度,所需胰岛素剂量及低血糖事件的差异;比较泵治疗前后两组胰岛β细胞功能改善程度的差异。结果在胰岛素泵治疗第2天,类似物组早晚餐后2h血糖即明显低于人胰岛素组(8·4mmol/L±2·8mmol/L比11·3mmol/L±3·8mmol/L,9·0mmol/L±2·4mmol/L比10·7mmol/L±2·8mmol/L,P<0·05),至第7天类似物组空腹和午餐后2h血糖降低程度也明显大于人胰岛素组(4·6mmol/L±0·8mmol/L比5·3mmol/L±0·9mmol/L,7·3mmol/L±2·2mmol/L比8·1mmol/L±1·8mmol/L,P<0·05)。治疗第14天,则只有空腹血糖存在差异;停止治疗后,空腹和早晚餐后2h血糖在两组间差异仍有统计学意义。类似物组获理想血糖控制时间短于人胰岛素组(2·0d比6·0d,P<0·01),所需胰岛素剂量又较小(0·6U/kg比0·8U/kg,P=0·002)。泵治疗前后胰岛β细胞功能指标如静脉葡萄糖耐量试验中胰岛素急性分泌时相、胰岛素和C肽曲线下面积,Homaβ,胰岛素原在两组间差异无统计学意义。治疗中两组仅见轻度低血糖事件:类似物组8例次(27%),人胰岛素组10例次(35%)。结论速效胰岛素类似物门冬胰岛素用于初诊2型糖尿病患者胰岛素泵强化治疗,和人胰岛素相比,可更快更好地改善空腹和餐后血糖,但对胰岛β细胞功能改善程度,差异无统计学意义。

The comparison of insulin aspart and human soluble insulin used in insulin pump therapy in newly diagnosed type 2 diabetic patients

OBJECTIVE: To compare the efficacy of insulin aspart and human soluble insulin used in insulin pump therapy on the islets beta cell function in newly diagnosed type 2 diabetic patients. METHODS: Fifty-nine hospitalized newly diagnosed type 2 diabetic patients, 35 males and 24 females, aged 51 +/- 12, were and randomly divided into 2 groups to undergo insulin pump therapy with insulin aspart (aspart group, n = 30) or human soluble insulin (humain insulin group, n = 29) for 2 weeks. The targets of glycemic control included fasting blood glucose (FBG) < 6.1 mmol/L and 2 h postprandial blood glucose (PBG) < 8.0 mmol/L. The changes of blood glucose, and the time and the doses of insulin needed for good glycemic control were compared between the two groups. The frequency of hypoglycemia and pump-related side effects were recorded. RESULTS: On the 2nd day of insulin pump therapy, FBG and 3 meals PBG levels were significantly reduced in both groups while the post-breakfast and post-dinner blood glucose levels were far more decreased in the aspart group than in the human insulin group (8.4 mmol/L +/- 2.8 mmol/L vs 11.3 mmol/L +/- 3.8 mmol/L, and 9.0 mmol/L +/- 2.4 mmol/L vs 10.7 mmol/L +/- 2.8 mmol/L, both P < 0.05). The FBG and 3 meals PBG were significantly lowered in the aspart group than in the human insulin group on the 7th day and after the stopping of insulin pump therapy. The time of good glycemic control of the aspart group was 2.0 d, significantly shorter than that of the human insulin group (6.0 d, P < 0.01). The mean dose of insulin used during insulin pump therapy in the aspart group was 0.6 U/kg, significantly less than that in the human insulin group (0.8 U/kg, P = 0.002). There was no significant difference in the AIR, mean area under the curve (AUC) of insulin and C peptide during IVGTT, HOMA-beta and proinsulin between the two groups before and after insulin pump therapy. No pump-related side effects were observed in both groups. CONCLUSION: In newly diagnosed type 2 diabetic patients with short term insulin pump therapy, the use of insulin aspart was more effective and faster with less doses of insulin in acquiring good glucose control compared with humulin R.