门冬胰岛素与人正规胰岛素对不规律进食老年2型糖尿病患者血糖影响的研究

Studies on effects of insulin aspart and human regular insulin on blood glucose in elderly type 2 diabetic patients with irregular food intake

目的：研究门冬胰岛素与人正规胰岛素对不规律进食老年2型糖尿病患者血糖的影响。方法：2006年2月至2007年4月老年2型糖尿病患者共33例[男性18例，女性15例，平均年龄（65．82±2．85）岁]被纳入研究，先后用方案A和方案B治疗，各4个月。方案A：三餐前30min皮下注射人正规胰岛素＋睡前皮下注射人低精蛋白锌胰岛素；方案B：三餐后10～15min皮下注射门冬胰岛素＋睡前皮下注射人低精蛋白锌胰岛素。每周检测2次空腹血糖（FBG）和早、午、晚餐后2h血糖；并对患者低血糖发生次数及其严重程度、糖化血红蛋白（HbA1c）变化进行对比观察。结果：患者的FBG和早、午、晚餐后2h血糖，在方案A治疗期间分别为（7．37±4．22）mmol／L、（9．73±3．38）mmol／L、（10．23±3．96）mmol／L和（10．85±3．36）mmol／L，在方案B治疗期间分别为（7．01±1．74）mmol／L、（9．23±1．58）mmol／L、（9．22±1．28）mmol／L和（9．76±1．32）mmol／L，差异有统计学意义（均P〈0．01）；方案B较方案A的餐后血糖波动幅度明显降低；治疗前后HbA1c的差值在方案A、B分别为（3．08±0．96）％和（3．37±0．47）％（P〈0．01）；低血糖发生次数及中重度低血糖发生率，在方案A治疗中分别为68例次及36．7％，在方案B治疗中分别为21例次及19．05％，差异有统计学意义（P〈0．001）。结论：门冬胰岛素餐后皮下注射可有效降低老年2型糖尿病患者的血糖，减小餐后血糖波动幅度，减少低血糖的发作次数并降低其严重程度，对不规律进食的老年糖尿病患者安全有效。

Objective： To study the effects of insulin aspart and human regular insulin on blood glucose in elderly type 2 diabetic patients with irregular food intake. Methods： Thirty-three elderly patients with type 2 diabetes mellitus [ 18 men, 15 women, average age （65.82 ± 2.85 ） years ] were enrolled in a clinical study from February 2006 to April 2007. They initially received regimen A （ SC human regular insulin 30 minutes before each meal and SC human isophane insulin at bedtime for 4 months） , followed by regimen B （SC insulin aspart 10-15 minutes after meals and SC human isophane insulin at bedtime for 4 months）. The fasting and 2-hour postprandial （after breakfast, midday meal, and evening meal） blood glucose levels were measured twice a week. The frequency and severity of hypoglycemia as well as the changes in glycosylated haemoglobin （HbAlc） levels were observed comparatively between the two regimens. Results： The fasting and 2-hour postprandial （after breakfast, midday meal, and evening meal） blood glucose levels were （7.37±4.22） mmol/L, （9.73 ±3.38） mmol/L, （10.23±3.96） mmol/L, and （10.85 ±3.36） mmol/L for regimen A, and （7.01 ±1. 74） mmol/L, （9. 23 ± 1.58） mmol/L, （9. 22 ± 1. 28） mmol/L, and （9.76 ± 1. 32） mmol/L for regimen B, respectively. The differences were statistically significant （all P 〈0.01 ）. The fluctuations of postprandial blood glucose were lower for regimen B than for regimen A. The difference values of HbAlc before and after treatment was （ 3.08 ± 0.96） % for regimen A and （ 3.37 ± 0.47） % for regimen B （ P 〈 0.01 ） , respectively. The frequency of hypoglycemia and the incidence of moderate-to-severe hypoglycemia were 68 cases and 36.70% for regimen A, and 21 cases and 19.05% for regimen B, respectively. The differences were statistically significant （ P 〈 0. 001 ）. Conclusion ： In elderly type 2 diabetic patients, subcutaneous injection of insulin aspart after meals can effectively decrease the blood glucose levels, reduce the fluctuation of postprandial blood glucose levels, and diminish the frequency and severity of hypoglycemia. It is a safe and effective regimen for elderly type 2 diabetic patients with irregular food intake.