预混胰岛素30R 3次注射与2次注射及其他胰岛素使用方法治疗2型糖尿病的血糖达标及安全性比较

Comparison of the effects and the security among three-injection,two-injection of premixed insulin 30R and other method used in insulin of type 2 diabetic patients

目的探讨预混胰岛素30R每日3次注射与每日2次注射及胰岛素R加甘精胰岛素或预混门冬氨酸胰岛素每日3次等多次胰岛素注射方法治疗血糖控制不良的2型糖尿病患者的疗效及低血糖风险。方法 2型糖尿病患者236例,其中64例应用预混胰岛素30R每日3次注射(A组)、58例每日2次注射(B组)、51例应用胰岛素R每日3次加甘精胰岛素每日1次注射(C组)、63例应用预混门冬氨酸胰岛素每日3次注射(D组),为期8周,比较治疗后各组观察胰岛素用量、空腹血糖(FPG)、餐后2h血糖(2hPG)、餐前血糖、低血糖发生率及最高血糖与最低血糖差值等。A组中的14例、B组中13例在血糖稳定后应用动态血糖监测系统(CGMS)观测血糖的漂移变化。结果 A组与C组胰岛素用量无显著差异(P>0.05),B组用量少于A和C组,D组胰岛素用量少于其他组,有显著差异(P<0.01)。各组患者治疗后FPG和餐后血糖均显著下降,FPG和午餐前血糖在各组间无显著差异(P>0.05),B组2hPG和晚餐前血糖高于其他组,组间有显著差异(P<0.01),A、C和D组间无显著差异(P>0.05)。低血糖发生率在A、C和D组间无显著差异(P>0.05),B组明显高于其他组,有显著差异(P<0.01)。最高血糖与最低血糖的差值在A、C和D组间无显著差异(P>0.05),B组明显高于其他组,有显著差异(P<0.01)。A组患者血糖漂移的最大幅度明显低于B组,有显著差异(P<0.01)。结论预混胰岛素30R每日3次注射比每日2次注射有更好的疗效及安全性,与胰岛素R加甘精胰岛素或预混门冬氨酸胰岛素每日3次注射的疗效类似。

[Objective] To study the abilities and associated hypoglycemia risks among three-injection,two-injection of premixed insulin 30R and other method used in insulin of type 2 diabetic patients.[Methods] 236 patients with type 2 diabetic were divided into four groups randomly：64 cases were treated with 3-injection daily of premixed insulin 30R（group A）,58 cases were injected with premixed insulin 30R 2-injection daily（group B）,51 cases were injected insulin R 3-injection daily additional glargine 1-injection daily（group C） and 63 cases were injected with insulin aspart 30/70 3-injection daily（group D） for 8 weeks.The dose of insulin,the fasting plasma glucose（FPG）,2 hours postprandial glucose（2hPG）,preprandial glucose,the incidence of hypoglycemia,the difference of the highest and the lowest plasma glucose were compared.The 14 cases in group A and the 13 cases in group B were used to measure glycemic excursions by continuous glucose monitoring system（CGMS） after treatment.[Results] Group A and group C were no significant differences in dose of insulin（P 0.05）.Dose of insulin used in group B was less than group A and group C.Dose of insulin used in group D was less than other group.The FPG,the 2hPG were significantly decreased in all group,the FPG and blood sugar before lunch were no significant differences among various group（P 0.05）,the 2hPG and blood sugar before supper in group B was higher than other group（P 0.01）.The incidence of hypoglycemic in group A,C,D were no significant differences（P 0.05）,group B was higher than other group（P 0.01）.The difference of the highest and the lowest plasma glucose were no significant differences in group A,C,D（P 0.05）,group B was higher than other group（P 0.01）.Glycemic excursions in group A was less than group B（P 0.01）.[Conclusion] Three injections of premixed insulin 30R daily is more safe and more effective than two injections of premixed Insulin 30R daily.