甘精胰岛素联合那格列奈治疗老年2型糖尿病32例

Efficacy Observation of Insulin Glargine Combined with Nateglinide in Treatment of Senile Type 2 Diabetes Mellitus

目的观察甘精胰岛素联合那格列奈治疗老年2型糖尿病的效果。方法将64例老年2型糖尿病患者随机均分为甘精胰岛素组(以下简称"甘精组)"和预混胰岛素组(以下简称"预混组")。甘精组于三餐前10 min口服那格列奈90～180 mg,晚10:00皮下注射甘精胰岛素;预混组于早晚餐前30min注射预混胰岛素。应用强生稳步血糖仪,每日监测两组患者三餐餐后2h血糖以及晚10:00、凌晨3:00、晨8:00指尖血糖,根据血糖值每2～3 d增减胰岛素剂量2～4 U。空腹血糖低于7.0 mmoL/L和餐后2h血糖低于10.0 mmol/L为血糖达标,观察血糖达标时间、胰岛素用量、低血糖发生次数和发生病例数,以及16周后患者的空腹血糖、餐后2 h血糖、糖化血红蛋白、体重指数。结果两组患者的血糖控制均达标,血糖达标时间差异无统计学意义;16周后空腹血糖、餐后2 h血糖、糖化血红蛋白比较,组间差异无统计学意义,治疗前后组内差异有统计学意义(P<0.01);甘精组体重指数无明显变化,预混组较治疗前明显增加(P<0.05);甘精组胰岛素日用量和低血糖发生病例数均显著低于预混组(P<0.01)。结论两种治疗方案对控制血糖都有效,但甘精胰岛素联合那格列奈能减少胰岛素的注射次数和日用量,降低低血糖风险,不增加体重指数,患者依从性好。

Objective To observe the effect of insulin glargine combined with nateglinide in the treatment of senile type 2 diabetes mellitus. Methods Sixty-four patients with type 2 diabetes were divided into 2 groups randomly;glargine group（32 cases）and pre-mixed insulin group（32 cases）.The glargine group was given oral nateglinide 90-180 mg at 10 min before breakfast,lunch and supper respectively and hypodermical injection of glargine once at 22 o＇clock every night,while the pre-mixed insulin group was hypodermically injected with the pre-mixed insulin at 30 min before breakfast and supper respectively.The fingertip capillary glucose was monitored by the Lifescan surestep glucometer at 2 h after breakfast,lunch and supper,22,3,8 o＇clock respectively.The dose of insulin were increased or decreased by 2-4 U every 2-3 d according to the level of blood glucose.Fasting plasma glucose（FPG）less than 7.0 mmol/L and 2 h PG less than 10.0 mmol/L were as reaching the targeted levels.The time for reaching the target levels,dosage of insulin,times of hypoglycemia and its cases number were observed.FPG,2 h PG,HbAlc and body mass index（BMI）were measured after 16 weeks.Results The glycemic control in both two groups were reached the targeted level and the difference of times for reaching the targeted level had no statistical significance.Comparing FPG,2 h PG and HbAlc after 16 weeks,the inter-group difference had no statistical significance,but the intra-group difference before and after treatment had statistical significance.BMI in the insulin glargine group had no obvious increase,while which after treatment in the premixed insulin group was significantly increased compared with before treatment（P0.05）.The incidence of hypoglycemia and the daily dose of insulin in the glargine group were lower than those in the pre-mixed insulin group（P0.01）. Conclusion Both the two treatment schemes are effective to control the blood glucose.But insulin glargine combined with nateglinide can reduce the times of insulin injection and the daily dose,lessen the hypoglycemia risk without increasing BMI and with good patient compliance.