动态血糖监测甘精胰岛素治疗老年2型糖尿病的研究

Effects of glargine on type 2 diabetes mellitus detected by continuous glucose monitoring system in the elderly

目的通过动态血糖监测(CGMS),评估甘精胰岛素治疗老年2型糖尿病(T2DM)的疗效和安全性。方法对39例口服药联合治疗空腹血糖控制不佳的老年T2DM患者,加用甘精胰岛素(IG)和中性鱼精蛋白锌胰岛素(NPH)睡前皮下注射,治疗12周。治疗前后测定空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、空腹C肽及餐后2hC肽等,并进行比较。结果治疗后,2组血糖和HbA1c均较治疗前下降(P<0·05或P<0·01),IG组血糖下降更明显(P<0·05),2组HbA1c无明显差异(P>0·05),IG组治疗后餐后2hC肽水平提高(P<0·05)。CGMS显示IG组24h血糖曲线平缓,血糖达标时间延长,夜间低血糖的发生率低(P<0·01),血糖波动幅度小。结论IG作为老年T2DM患者的基础胰岛素替代治疗,血糖控制达标率高,胰岛素剂量控制更方便、安全,优于NPH。

Objective To evaluate the efficacy and safety of glargine in the treatment of type 2 diabeties mellitus （T2DM） in elderly patients by continuous glucose monitoring system（CGMS）. Methods Thirty-nine aged patients with T2DM （mean age ,68 ±8 years） with poor fasting plasma glucose（FPG） control on oral antidiabetic agents randomly received treatment for 12 weeks with bedtime insulin glargine（ IG group） or bedtime NPH insulin（ NPH group）. Previous oral antldiabetic therapy was continued throughout the study. The levels of FPG,2 h postprandial blood glucose（2hPG） , HbAlc, C-peptide were detected before and after treatment. Results The levels of FPG,2hPG, HbAlc were significantly decreased after treatment in both groups （ P 〈 0.05 or P 〈 0. 01 ） , while the levels of FPG and 2hPG in IG group were lower than those in NPH group （ P 〈0. 05） ;the level of 2 h postprandial C-peptide was significantly increased in IG group（ P 〈 0.05）. There were no significant differences in HbAlc, fasting C-peptide between IG group and NPH group （ P 〉 0. 05 ）. And 24 h blood glucose curve was placid shown by CGMS. The incidence of low blood glucose in IG group was lower than that in NPH group（ P 〈 0. 01 ）. Conclusions As replacement for basic insulin treatment, IG can more quickly and safely control the blood glucose level than NPH.