采用两种不同胰岛素制剂用胰岛素泵长期治疗的差异

The differences between novolin R and novolog (aspart) during long period pump therapy

目的比较两种不同的胰岛素制剂用胰岛素泵长期治疗时的差异。方法15个胰岛素泵治疗的1型糖尿病人分别用诺和灵R及诺和锐各治疗3月以上,比较其疗效。结果诺和锐显著减少了泵的胰岛素总量,基础率无明显改变而总追加量及低血糖事件显著减少。但改用诺和锐后导管堵塞次数增加,2人由此引发酮症酸中毒住院治疗。结论超短效胰岛素可较短效胰岛素更好地控制用胰岛素泵长期治疗患者的血糖,使胰岛素用量减少,血糖更趋平稳。但其易引发导管堵塞,故坚持血糖监测非常重要。

Objective To compare the differences in clinical efficacy between novolin R and novolog （aspart） in a long period pump therapy. Methods 15 patients with T1DM were treated by novolin Rpump at beginning, and then changed to aspart-pump for more than 3 months （3-18 months）. SMBG was done at least 3 times a day. Total daily insulin dose（TDD）, pump basal rate （BR）, total bolus, frequency of hypoglycemic episodes, HbA1c, incidence（ %） of BG fluctuation （≥ 16.7 mmol/L or ≤ 3. 5 mmol/L） and side-effects were compared. Results The aspart therapy group showed the similar SMBG times, BR doses and HbA1c as compared with novolin R therapy group （all P〉0. 05）. The TDD （0. 55±0. 06 vs 0. 79± 0. 08 U · kg^-1 · d^-1 ）, frequency of hypoglycemic episodes （0.05±0.01 vs 0.11± 0. 02 times · d^-1 ）, incidence of hypoglycemic （43.5 mmol/L） fluctuation （5.3%±0.8% vs 11.4± 1.7%）, total bolus doses （0.28±0.03 vs 0. 47±0. 06 U · kg^-1 · d^-1 ） significantly reduced （P〈0. 05） in aspart group than in novolin R group. The pump tubular clog times were more in aspart group （42 times）than in novolin R group （22 times） （P〈0. 05）. Aspart-induced pump tubular clog caused DKA in 2 patients. Discussion This observation showed that while compared with novolin R group, the insulin aspart group reduces significantly the postprandial BG, the frequency of hypoglycemic episodes and insulin dosage, but increases the times of tubular clogs and may cause DKA.