胰岛素泵、门冬胰岛素30与甘精胰岛素加瑞格列奈治疗高血糖状态的疗效比较

Comparison of therapeutic effects between insulin pump,insulin aspart 30 and insulin glargine combined with repaglinide in treating hyperglycemia

目的比较采用映岛素泵、门冬胰岛素30与甘精胰岛素加瑞格列奈治疗高血糖状态的疗效。方法179例血糖控制差的2型糖尿病患者，随机分为A、B、C3组，分别采用胰岛素泵（57例，2周后改用门冬胰岛素30）、门冬胰岛素30（63例）与甘精胰岛素加瑞格列奈（59例）治疗，观察3组治疗前后血糖、糖化血红蛋白（HbAlc）或果糖胺（FMN）水平变化，以及胰岛素剂量及低血糖发生率。结果（1）3组血糖治疗后与治疗前比较各时点差异均有统计学意义（P〈0．001）。3组治疗后血糖除C组凌晨3：00高于其他两组外（P〈0．05），其他各时点无统计学差异。（2）3组糖化血红蛋白治疗后与治疗前比较均有统计学差异（P〈0．001）、但治疗后3组间比较无统计学差异。A组治疗2周前后果糖胺差异有统计学意义（P〈0．001）。（3）3组严重低血糖、轻度有症状低血糖发生均有统计学意义（P〈0．001），轻度无症状低血糖发生无统计学差异。结论胰岛素泵、门冬胰岛素30及甘精胰岛素＋瑞格列奈治疗均可满意地降低各时点血糖及糖化血红蛋白或果糖胺。低血糖发生率胰岛素泵组最大，甘精胰岛素组最小。

Objective To study the therapeutic effects of insulin pump,insulin aspart 30 and insulin glargine combined with repaglinide in treating hyperglycemia. Methods 179 patients with type 2 diabetes mellitus with poor blood glucose control were grouped by insulin pump for two weeks followed by insulin aspart 30 （n = 57 ）, insulin aspart 30 （n = 63 ）, and insulin glarg/ne combined with repaglinide for sixmonths（ n = 59）. The blood glucose, glyeosylated hemoglobin and fructosamine before and after treatment were observed. Results （ 1 ） There were statistically significant differences in blood glucose at various points in 24 hours between the three groups（ P 〈 0. 001 ）. After treatment there were no significant differences at other points but higher blood glucose at three o＇ clock in insulin glargine combined with repaglinide group than in other two groups （P 〈 0.05 ）. （2）There were statistically significant differences in glyeosylated hemoglobin between insulin aspart 30 and insulin glargine combined with repaglinide group before and after treatment（ P 〈 0.001 ） ,but after treatment there was no significant difference between the two groups. （3）Therewere statistically significant differences in serious and slight symptomatic hypoglycemia between the three groups （P 〈 0. 001 ）. Conclusions All the above three treatmeats can reduce the blood glucose, glycosylated hemoglobin or ffuctosamine satisfactorily. The maximum hypoglycemia rate occurs in insulin pump group and minimum hypoglycemia rate iu insulin glargine group.