中效胰岛素联合那格列奈与预混胰岛素治疗2型糖尿病疗效比较

Efficacy and safety of nateglinide combined with NPH insulin compared with mexed type insulin in patients with type 2 diabetes mellitus

目的:预混胰岛素血糖控制不佳者改用那格列奈联合中效人胰岛素(NPH)在2型糖尿病患者中的有效性及安全性。方法:选择应用预混人胰岛素3月及以上血糖控制不佳的2型糖尿病患者108例,分为2组,一组(42例)维持原方案的基础上调整预混胰岛素用量,另一组(66例)改用那格列奈联合中效人胰岛素治疗,随访3月及6月,比较治疗前后两组空腹血糖(FBG),餐后2 h血糖(2hPBS),糖化血红蛋白(HbA1c)及低血糖发生率,体重变化情况。结果:那格列奈联合中效人胰岛素与预混胰岛素治疗3月和1年时比较,FBG、2hPBS及HbA1c较治疗前均明显下降;同时低血糖发生率减少;体重及体重指数3月后无明显变化但1年后有所降低。结论:2型糖尿病患者应用那格列奈联合中效胰岛素能更好控制血糖;同时减少低血糖的发生率,不增加体重,兼顾了治疗的有效性及安全性,疗效优于预混胰岛素。

Objective：To compare the efficacy and safety of nateglinide＋NPH insulin with mixed type insulin in patients with type 2 diabetes mellitus（T2DM）.Methods：A total of 108 patients whose blood glucose poorly controlled by mixed type insulin were treated by either nateglinide＋NPH insulin or mixed type insulin.During 3 and 6 months of treatment,the changes in fasting blood glucose（FBG）,2-h postprandial blood glucose（PBG）,glycosylated hemoglobin A1c（HbA1c） as well as body weight and hypoglycemia were recorded.Results：At 3 and 6 months after treatment,nateglinide＋NPH insulin showed better efficacy than mixed type insulin,the reduction was（6.82±1.52） vs（8.21±2.35）（3 month） and（6.42±2.03） vs（7.85±3.78）（6 month） in FBG;（9.86±4.35） vs（11.01±4.67）（3 month） and（12.32±4.83） vs（9.03±4.56）（6 month） in 2-h PBG;（7.75±0.71） vs（8.64±0.83）（3 month） and（6.54±0.69） vs（7.85±0.76）（6 month） in HbA1C level.The body weight was decreased more,and the occurrence of hypoglycemia was lower in nateglinide＋NPH insulin group.Conclusion：Combination of nateglinide with NPH insulin can control blood glucose and HbA1C better,and induce less hypoglycemia than mixed type insulin.Its efficacy and safety are improved for treatment of T2DM.