甘精胰岛素联合瑞格列奈治疗老年2型糖尿病的疗效观察

Efficacy of insulin glargine combined with repaglinide in treatment of type 2 diabetes mellitus in elders

目的观察老年2型糖尿病(T2DM)病人甘精胰岛素联合瑞格列奈降糖治疗的效果。方法 60例T2DM患者随机分为甘精组和预混组,甘精组三餐前15 min口服瑞格列奈0.5～1.0 mg,晚10∶00皮下注射甘精胰岛素。预混组于早晚饭前30 min注射预混胰岛素,应用罗康全血糖仪,住院期间监测空腹、三餐后2 h、夜10∶00、夜3∶00指尖血糖,根据血糖调整胰岛素剂量。空腹血糖(FPG)<7.0 mmol/L,餐后2 h血糖(2 hPG)<10.0 mmol/L为达标。观察血糖达标时间、胰岛素用量、低血糖发生次数、发生人数;12周后的FPG、2 hPG、糖化血红蛋白(HbAlc)、体质量指数(BMI)。结果两组血糖控制均达标,预混组和甘精组12周后,FPG2、hPG、HbA1c组间差异无统计学意义(P>0.05),组内与治疗前相比差异有统计学意义(P<0.01)。两组血糖达标时间差异无统计学意义(P>0.05),甘精组BMI较治疗前无明显增加(P>0.05),预混组BMI较治疗前明显增加(P<0.05)。甘精组胰岛素日用量、低血糖发生人数显著低于预混组(P<0.01),差异有统计学意义。结论两种治疗方案对控制血糖都有效,但甘精胰岛素联合瑞格列奈降糖治疗方案能减少注射次数和胰岛素的日用量,减少低血糖风险,不增加体质指数,依从性好。

To observe the efficacy of insulin glargine combined with repaglinide in treatment of type 2 diabetes in elders. Methods Sixty patients with type 2 diabetes were randomly divided into 2 groups, glargine group （30 cases） and mixed insulin group （30 cases）. In glargine group, patients were given with 0.5～1 mg repaglinide 15 minutes before breakfast, lunch and supper respectively and hypodermic injection of insulin glargine once at 22 o’lock every night, while patients in mixed insulin group were hypodermically injected with mixed insulin 30 minutes before breakfast and supper respectively. The blood level of capillary glucose was monitored by Accu - Chek glucometer at fasting, 2 hours after breakfast, lunch and supper, at 22 o’lock and 3 o’lock respectively in hospital. The dosage of insulin was adjusted according to blood level of glucose. The aim of treatment was FPG less than 7.0 mmol/L and 2 hPG less than 10.0 mmol/L. The duration for reaching the aim, dosage of insulin, blood level of glucose and incidence of hypoglycemia were observed. FPG, 2hPG, HbAlc and body mass index （BMI） were measured after treatment for 12 weeks. Results The daily glucose profile and level of HbAlc in patients of these 2 groups were obviously dropped after treatment for 12 weeks （allP 〈0.01）. At the end of trial, FPG, 2HPG and level of HbAlc werent markedly different in2 groups （ P 〉0.05）. The duration for reaching the aim was similar in 2 groups （ P 〉 0.05 ） ; and the body mass index （BMI） was markedly increased in mixed insulln group compared with pre - trial （ P 〈 0.05 ）, but no significant change was found in glarglne group （ P 〉 0.05 ）. The incidence of hypoglycemia in glargine group was significantly lower than that of mixed insulin group （ P 〈0.01 ）. The daily dosage of insulin in glargine group was significantly lower than that of mixed insulin group （ P 〈 O. 01 ）. Conclusion Both of mixed insulin and insulin glargine combined with repaglinide have visible effects on controlling bltood level of glucose, but the latter has better efficacy, better adherence and lower risk of hypoglycemia, it will not increase the body mass index, and it can decrease the frequency of injection and daily dosage of insulin.