德谷胰岛素与甘精胰岛素治疗口服药物控制不佳的2型糖尿病患者疗效对比

Comparison of therapeutic effects of insulin degludec and insulin glargine in the treatment of type 2 diabetes mellitus patients with poor oral drug control

目的探讨口服足量二甲双胍血糖控制不佳的2型糖尿病患者联合德谷胰岛素或甘精胰岛素治疗2型糖尿病的临床疗效及安全性。方法选取2019年1月-2020年1月于本院内分泌科就诊的125例2型糖尿病患者,使用足量二甲双胍治疗三个月以上糖化血红蛋白均不达标,以糖化血红蛋白7.5%为切点,按照就诊顺序分为二甲双胍联合德谷胰岛素组(观察组)和甘精胰岛素联合二甲双胍组(对照组)。其中,观察组61例,对照组64例,均治疗18周。随访内容包括FPG、2h-PG、HbA1C、体重以及胰岛素用量和低血糖事件数量、血糖波动;采用SPSS 18.0软件进行t检验和χ^(2)检验。结果治疗前两组患者空腹血糖、早餐后2h血糖和糖化血红蛋白水平比较,差异均无统计学意义(P>0.05)。治疗18周后,早餐后2h血糖、糖化血红蛋白均无统计学差异(P>0.05),空腹血糖差异有统计学意义(P<0.05)。观察组的低血糖发生率[1.6%]低于对照组[6.25%],胰岛素用量(19.25±3.64)U低于对照组(32.67±5.81)U,有统计学意义(P<0.05)。两组均无严重低血糖反应发生,血糖波动有统计学差异(P<0.05)。结论二甲双胍联合德谷胰岛素治疗2型糖尿病,降糖效果好、安全性高,低血糖风险低,患者生活质量较高。

Objective To discuss the clinical efficacy and safety of the combination of insulin degludec or insulin glargine in the treatment of type 2 diabetes mellitus in patients with type 2 diabetes who have poor blood sugar control with adequate oral metformin.Methods Total of 125 patients with type 2 diabetes mellitus who were treated in the Endocrinology department of our hospital from January 2019 to January 2020 were selected.The glycated hemoglobin was not up to the standard after treatment with sufficient metformin for more than three months,and 7.5%glycated hemoglobin was taken as the cut-off point.According to the order of treatment,the patients were divided into two groups:metformin combined with insulin degludec group(observation group)and insulin glargine combined with metformin group(control group).Among them,61 cases in the observation group and 64 cases in the control group were treated for 18 weeks.Follow-up contents included FPG,2h-PG,HbA1C,body weight,insulin dosage,number of hypoglycemic events,and blood glucose fluctuation;SPSS 18.0 software was used for t test andχ^(2)test.Results Before treatment,there was no significant difference in fasting blood glucose,blood glucose 2 hours after breakfast and glycosylated hemoglobin between the two groups(P>0.05).After 18 weeks of treatment,there was no significant difference in blood glucose and glycosylated hemoglobin 2 hours after breakfast(P>0.05),but there was a significant difference in fasting blood glucose(P<0.05).The incidence of hypoglycemia in the observation group(1.6%)as lower than that in the control group(6.25),and the insulin dosage(19.25±3.64)U was lower than that in the control group(32.67±5.81)U,with statistical significance(P<0.05).There was no severe hypoglycemia reaction in the two groups,and the blood glucose fluctuation was statistically different(P<0.05).Conclusion Metformin combined with insulin degludec in the treatment of type 2 diabetes has good hypoglycemic effect,high safety,low risk of hypoglycemia,and high quality of life of patients.