速效胰岛素类似物与人胰岛素在2型糖尿病胰岛素泵中应用的比较

Comparison of insulin aspart and human soluble insulin during insulin pump therapy in type 2 diabetes

目的:人胰岛素作为泵用胰岛素已有较多的经验,而速效胰岛素类似物应用尚不广泛,文中旨在比较这2种剂型在泵输注中的有效性、安全性和应用特点。方法:共345例2型糖尿病患者,随机以门冬胰岛素和优泌林R作为泵用胰岛素进行CSII强化治疗(门冬胰岛素组173例,优泌林R组172例),监测1 d 9次末梢血糖(3餐前后,睡前,0AM和3AM),并观察不同时间段胰岛素用量。结果:2组患者血糖达标时间分别为(4.40±2.16)d和(5.68±2.29)d,门冬胰岛素组达标时间较短(P<0.05),达标时2组每日胰岛素用量类似;门冬胰岛素组白天段基础率较低,但中餐前大剂量较高;泵治疗后2组各时间点血糖均明显降低,但门冬胰岛素组对空腹和早、晚餐后血糖控制更好,低血糖的发生明显较低(P<0.05)。结论:在CSII强化治疗中,门冬胰岛素可更快、更有效降低血糖,且低血糖风险更低;优泌林R组基础率占日总量的比例较低,主要是白天段基础率。

Objective： Continuous subcutaneous insulin infusion（CSII） with human insulin has been available for many years,but only recently have reports of efficacy with rapid-acting insulin analogues been published.The purpose of this study is to compare the efficacy,safety and the difference character between the two type insulin form in CSII. Methods： A total of 345 patients with type 2 diabetes were recruited and randomized into Groups A（n = 173） and B（n = 172）,treated with insulin aspart and humulin R,respectively,by CSII.Capillary glucose concentrations were measured at 9 time points,before and after the three meals,at bedtime（10 p.m.）,midnight（0 a.m.） and 3 a.m.every day during the treatment. Results： The time to achieve good glycemic control was（4.40 ± 2.16） d in Group A,significantly shorter than（5.68 ± 2.29） d in Group B（P 0.05）,but the total insulin dose was similar between the two groups（P 0.05）,and the dose of basal insulin was smaller in the former than in the latter（P 0.05）.After the treatment,blood glucose was significantly reduced in both of the groups,while the levels of fasting blood glucose and post-breakfast and post-dinner blood glucose were far more decreased in Group A than in B（P〈0.05）.The incidence of hypoglycemia was significantly lower in the aspart group than in the humulin R group（P〈0.05）.Conclusion： Insulin aspart can effect a better control of blood glucose and a lower incidence of hypoglycemia than Humulin R in diabetic patients during the CSII treatment.The basal insulin dose is smaller in the insulin aspart group than in the human insulin group,especially in the daytime.