初诊2型糖尿病两种胰岛素强化治疗方法的比较

Observation on Two Kinds of Intensification Insulin Therapy for Newly Diagnosed Type 2 Dia- betes Mellitus

【目的】观察诺和锐30R三餐前皮下注射与诺和锐R三餐前皮下注射加睡前注射来得时在初诊的2型糖尿病患者的疗效，胰岛素用量和低血糖风险。【方法】将本科2009年2月至2010年2月期间68例初诊的2型糖尿病住院患者随机分成A、B组，A组使用诺和锐30R三餐前皮下注射；B组使用诺和锐R三餐前皮下注射加睡前注射来得时，出院后继续治疗，为期12周。观察两组患者5个时点（空腹及三餐后2h，睡前）的血糖、糖化血红蛋白（HbAlc），每天胰岛素平均用量及低血糖事件的差异。【结果】两组患者经过胰岛素治疗后各时点血糖及HbAlC均较治疗前明显下降（P〈0．05），A和B两组胰岛素强化治疗方法均有效，但A组胰岛素用量、血糖达标时间、住院天数、低血糖发生率均低于B组、有统计学差异（P〈0．05）。【结论】对于初诊2型糖尿病患者，每天3次餐前注射诺和锐30R是一种快速、有效、安全的强化治疗方法。

[Objective] To observe the efficacy of two kinds of intensive insulin therapy（three short and a long） such as the injection of aspart 30R three times a day or the injection of aspart R before the meal combined with Lantus at bedtime for the treatment of newly diagnosed type 2 diabetes mellitus. [Methods] Totally 68 patients with newly diagnosed type 2 diabetes mellitus in our department from Feb. 2009 to Feb. 2010 were randomly divided into group A and group B. Group A received subcutaneous injection of pre-meal aspart 30R and group 13 group received subcutaneous injection of pre-meal aspart R plus Lantus at bedtime. After dis-charge, the treatment continued for 12 weeks. Blood glucose, glycosylated hemoglobin（HbAlc）, the average daily insulin dose and hypoglycemia at 5 time points（fasting and 2h after 3 meals, bedtime） were observed. [Results] Compared with before insulin therapy, blood glucose and HbAlc at each time point decreased after insulin therapy（ P 〈0.05）. Two kinds of intensive insulin therapy were effective, but the insulin dosage, the time of target blood glucose, hospital stay and the incidence of hypoglycemia in group A were lower than those in group B, and there were significant differences（ P 〈0.05）. [Conclusion] For newly diagnosed type 2 dia- betic patients, the injection of aspart 30R three times a day is a fast, effective and safe method of intensive in- sulin therapy.