门冬胰岛素与人普通胰岛素在老年2型糖尿病胰岛素泵治疗中的疗效比较

Comparison between the effects of insulin Aspart and Novolin R via continuous subcutaneous insulin infusion pump on hyperglycemia in elderly patients with type 2 diabetes

目的比较胰岛素泵输注速效胰岛素类似物(门冬胰岛素,诺和锐)与人普通胰岛素(诺和灵R)治疗老年2型糖尿病高血糖的疗效及安全性。方法118例血糖控制不佳的老年2型糖尿病患者行胰岛素泵强化治疗,随机选择泵用门冬胰岛素或人普通胰岛素,比较组间血糖、血糖达标时间、血糖达标时胰岛素用量、治疗过程中低血糖发生率更低(0.13例次/d,0.18例次/d,P<0.01)血糖的波动及低血糖的发生。结果门冬胰岛素组较人胰岛素组血糖达标时间更短〔(6.0±2.8)d vs(7.6±3.7)d,P<0.05〕,平均餐后血糖控制更佳〔(8.0±0.9)mmol/L vs(8.5±0.8)mmol/L,P<0.05〕,胰岛素泵餐前量比重更小〔(54.9±10.2)%vs(60.0±8.5)%,P<0.01〕,治疗过程中血糖波动更小,即治疗前4天血糖标准差更小〔(3.0±1.0)vs(3.8±1.3),P<0.05〕,两组血糖达标时胰岛素用量无统计学差异。结论老年2型糖尿病的胰岛素泵治疗中,输注门冬胰岛素较人胰岛素餐后血糖控制更佳,胰岛素泵餐前量比重更低,血糖达标时间更短,治疗过程中血糖波动更小。

Objective To compare the efficacy and safety of rapid-acting（human insulin analogue Aspart and regular human insulin Novolin R delivered with continuous subcutaneous insulin infusion（CSII） pump on hyperglycemia in elderly patients with type 2 diabetes.Methods 118 elderly patients with poorly-controlled type 2 diabetes in hospital were randomized to Group A（n=61,treated with insulin Aspart） or Group B（n=57,treated with Novolin R）.Insulin Aspart and Novolin R were administered by CSII.All patients were treated to achieve target glycaemic control.The blood glucose,the time and the dose of insulin needed for good glycemia control were compared between the two groups,the fluctuations of blood glucose and incidence of hypoglycaemia were evaluated too.Results The time for good glycemia control was shorter in group A than that in group B（（6.0±2.8） d vs（7.6±3.7） d,P0.05）,the mean of three postprandial blood glucose were significantly lower in group A than that in group B（（8.0±0.9） mmol/L vs（8.5±0.8） mmol/L,P0.05） with lower proportion of bolus before meal to daily total insulin dosage（（54.9±10.2）% vs（60.0±8.5）%,P0.01）.The incidence of hypoglycemia was significantly higher in group B（0.18 person-time/d vs 0.13 person-time/d,P0.01）,the standard deviation of blood glucose,which reflected the fluctuation of blood glucose was significantly lower in group A than that in group B（（3.0±1.0） vs（3.8±1.3）,P0.05）.There were no significant differences in basal or bolus insulin dosages between the two groups.Conclusions In elderly type 2 diabetic patients,insulin Aspart provides a more effective control of postprandial hyperglycemia,with lower proportion of bolus before meal to daily insulin dosage than regular human insulin（Novolin R） via continuous subcutaneous insulin infusion pump.It can control the hyperglycemia rapidly with lower flucuations of blood glucose than Novolin R.Insulin Aspart might be the better choice for elderly type 2 diabetic patients using CSII.