甘精胰岛素联合瑞格列奈治疗老年2型糖尿病患者的疗效与安全性

Efficacy and safety of glargine combined with repaglinide in treatment of type 2 diabetes mellitus in the elderly

目的观察什精胰岛素沣射液联合口服降糖药物瑞格列奈对老年2型糖尿病患者的血糖控制情况和低血糖的风险。方法选择口服降糖药物血糖控制不良的老年2型糖尿病患者64例，随机分为甘精胰岛素组（简称甘精组）和预混胰岛素组（诺和灵30R，简称预混组），每组各32例。甘精组在每天3餐前口服瑞格列奈的基础上，每晚22时注射甘精胰岛素1次；预混组每天早、晚餐前分别注射诺和灵30R预混胰岛素；根据空腹血糖及餐后血糖的水平，每3天调整瑞格列奈及胰岛素剂量，以空腹血糖〈7．2mmol／L，餐后血糖〈10.0mmol／L为治疗目标，共治疗16周，观察血糖控制和低血糖发生情况。结果治疗16周后两组的全天血糖谱和糖化血红蛋白（HbAlc）有明显下降（P〈0．05），甘精组全天各时点血糖均值低于预混组，其中午餐后、晚餐后2h血糖与预混组比较，差异有统计学意义（均为P〈0.05），甘精组HbAlc值明显低于预混组（P〈0.05）；体质指数（BMI）甘精组无明显增加（P〉0．05），预混组BMI较治疗前明显增加（P〈0．05）；甘精组低血糖事件明显少于预混组（甘精组2例，6．3％；预混组12例，37.5%；P〈0.05）。结论老年2型糖尿病患者在单用口服降糖药小能良好控制血糖时，应用每天1次甘精胰岛素加瑞格列奈口服或改用每天2次预混胰岛素治疗均能达到控制血糖效果，甘精胰岛素降低午餐后、晚餐后血糖及HbAlc的效果更好，低血糖发生半低，体质量未见明显增长。

Objective To compare the blood glucose level and associated hypoglycemia risks between group of insulin glargine combined with repaglinide and group of mixed insulin in the treatment of type 2 diabetes in the elderly. Methods Sixty four type 2 diabetes patients （age≥60 years） with inadequate glycaemic control by drugs were divided into 2 groups randomly： glargine group （32 cases） and mixed insulin group （32 cases）. In glargine group, 32 patients were given repaglinide before breakfast, lunch, ,supper respectively and injection of glargine hypodermically once at 22 o＇clock every night, while the 32 patients in mixed insulin group were injected with the mixed insulin （Novolin 30R） hypodermically before breakfast and supper respectively for 16 weeks. The dose of repaglinide and insulin were adjusted every 3 days according to the level of fasting glucose （FPG） and postprandial glucose （PPG）, reaching the aim of FPG less than 7.2 mmol/L and PPG less than 10 mmol/L. The blood glucose level and the incidence of hypoglycemia were observed. Results The daily glucose profile and the level of HbAlc of the 2 groups dropped obviously after 16 weeks treatments （all P〈0.05）. At the end of the experiment, the PPG of lunch and supper, and the level of HbAlc were markedly lower in glargine group than in mixed insulin group （all P〈0.05）, and the body mass index （BMI） increased markedly in mixed insulin group compared with pre-experiment （P〈0.05）, but no significant change was found in glargine group （P〉0.05）. The incidence of hypoglycemia in glargine group was lower than that in mixed insulin group （2 patients in glargine group, 12 patients in mixed insulin group, P〈0.05）. Conclusions Both of the mixed insulin and glargine combined with repaglinide have visible effects on controlling the blood glucose, but the latter has better efficacy, lower risk of hypoglycemia and lower increase of BMI than the former.