基础胰岛素联合口服药治疗血糖控制不佳的2型糖尿病患者的影响因素研究

目的 探讨基础胰岛素联合口服降糖药方案在血糖控制不佳的2型糖尿病患者治疗的影响因素。方法 选取邯郸市中心医院内分泌科收治的208例血糖控制不佳的2型糖尿病住院患者，给予胰岛素多次皮下注射（MDI）治疗，达到血糖控制目标后改为基础胰岛素加口服药治疗（BOT方案），如2周后空腹血糖（FPG）和餐后2 h血糖（2 hPG）均达标则归入成功组；如未达标则归入未成功组，并转为MDI方案治疗。比较2组糖尿病病程、体质量指数（BMI）、空腹C肽（FC-P）、餐后2 hC肽（2 hC-P）等基线资料以及在胰岛素强化治疗时基础胰岛素用量、餐时胰岛素用量及胰岛素总量。分析BOT方案在血糖控制不佳的2型糖尿病患者中应用的影响因素。结果 与未成功组相比，成功组糖尿病病程较短6.50（1.00，10.00）年 vs. 10.00（3.25，15.00）年，P<0.01]，BMI、FC-P、2 hC-P、转换方案前基础胰岛素量高于未成功组（P<0.05）。多因素Logistic回归分析结果显示，糖尿病病程长的患者BOT方案可能不成功（OR=0.930，95%CI：0.876~0.987，P=0.017），而高水平BMI（OR=1.145，95%CI：1.003~1.308，P=0.045）、2 hC-P（OR=2.866，95%CI：1.938~4.239，P<0.001）、基础胰岛素用量（OR=1.254，95%CI：1.119~1.406，P<0.001）有助于BOT方案的成功。结论 血糖控制不佳的2型糖尿病患者经过胰岛素强化治疗后能否转换为基础胰岛素加口服药，主要受病程、BMI、2 hC-P、基础胰岛素用量等因素的影响。

Study on the influencing factors of basal insulin combined with oral medication in the treatment of type 2 diabetes with poor glycemic control

Objective To investigate the influencing factors of basal insulin combined with oral medication in type 2 diabetic patients with poor glycemic control. Methods A total of 208 patients with type 2 diabetes mellitus with poor blood glucose control were selected from the Department of Endocrinology of Handan Central Hospital. Patients were treated with multiple daily injections of insulin (MDI) after admission. After achieving and maintaining the blood glucose control target for 1 week, the islet function was evaluated and the therapy was shifted to basal insulin-supported OAD (S) therapy (BOT). Patients were classified as the achieving group, if fasting plasma glucose (FPG) and 2 h postprandial plasma glucose (2 hPG) reached the control target after 2 week. Others would be classified as the underachieving group. Patients in the achieving group who maintained their target at least 3 months were deemed to be responded to the BOT. Patients who failed to achieve the target were transferred to the underachieving group and received the MDI program. The baseline data of the two groups were compared, including duration of diabetes, body mass index (BMI), FC-P and 2 hC-P. The dosage of basal insulin and preprandial insulin during intensive insulin therapy were compared between the two groups. The influencing factors of BOT program in type 2 diabetes patients with poor blood glucose control were analyzed. Results Compared with the underachieving group, the achieving group had shorter duration of diabetes 6.50 (1.00, 10.00) years vs. 10.00 (3.25, 15.00) years，P<0.01], and higher BMI, FC-P, 2 hC-P and basal insulin dosage before conversion (P<0.05). Multivariate Logistic regression analysis showed that BOT program might not be successful in patients with long course of diabetes (OR=0.930, 95%CI: 0.876-0.987, P=0.017), while high levels of BMI (OR=1.145, 1.003-1.308, P=0.045), 2 hC-P (OR=2.866, 1.938-4.239, P<0.01) and basal insulin dosage (OR=1.254, 1.119-1.406, P<0.01) could promote the success of BOT program. Conclusion The duration of diabetes, BMI, 2 hC-P and the dosage of basal insulin are main factors influencing the conversion of type 2 diabetic patients with poor glycemic control to basal insulin combined with oral medication after intensive insulin therapy.