加用甘精胰岛素对老年肥胖2型糖尿病口服降糖药控制不佳患者的疗效

The therapeutic effect of insulin glargine versu NPH insulin as add-on therapy to previous acarbose or metformin in senile obese type 2 diabetics

目的研究口服降糖药控制不佳的老年肥胖T2DM患者加用甘精胰岛素或中效胰岛素联合应用治疗的有效性和安全性。方法将口服降糖药控制不佳的老年肥胖T2DM患者61例随机分为甘精胰岛素组和中效胰岛素组,治疗期内阿卡波糖和(或)二甲双胍剂量不变,分别加用甘精胰岛素或中效胰岛素每晚睡前注射1次联合治疗,进行12周的观察。结果 (1)两组HbA1c、FPG、2hPG与治疗前比较以及两组间HbA1c、2hPG比较,差异有统计学意义(P<0.05),两组间FPG比较差异无统计学意义(P>0.05);(2)甘精胰岛素组BMI与治疗前比较降低了2.7kg/m2,而中效胰岛素组BMI与治疗前比较基本没有改变;(3)甘精胰岛素组和中效胰岛素组分别有45.2%和73.3%的患者发生症状性低血糖,差异有统计学意义(P<0.05);(4)治疗结束时甘精胰岛素组与中效胰岛素组胰岛素用量分别为(18.7±3.5)U/d和(26.0±3.7)U/d,差异有统计学意义(P<0.05)。结论口服降糖药血糖控制不佳的老年肥胖T2DM患者,在阿卡波糖和(或)二甲双胍基础上加用甘精胰岛素能有效控制血糖,降低低血糖的发生率,并能有效地控制体重。

Objective To study the effectiveness and safety of insulin glargine versus isophane insulin as add-on therapy to previous OHA in senile obese type 2 diabetic patients who failed to control their blood glucose with oral hypoglycemic agents （OHA）. Methods Sixty-one patients who failed to control their blood glucose with OHA were randomized into insulin glargine group and isophane insulin group. They were administered previous acarbose and/or metformin tablet and insulin glargine or isophand insulin as add-on therapy. The observation lasted for 12 weeks. Result （1） Both groups showed significant difference in HbA1c, FPG, and 2 hPG compared with before treatment, and in HbA1c and 2 hPG between the two groups （all P〈0.05） ; while there was no significant difference in FPG between the two groups （P〈0. 05）. （2） The BMI of the insulin glargine group was reduced by 2. 7 kg/m2 compared with before treatment, while that of the isophand insulin group was basically unchanged compared with before treatment. （3） The 45. 2% of patients with insulin glargine treatment and the 73.3% of patients with isophand insulin treatment had symptomatic hypoglycemia, and the difference was statistically significant （P〈0. 05）. （4） At the end of treatment, the dose of insulin glargine group and isophand insulin group was （18. 7±3. 5） U/d and （26. 0±3. 7） U/d respectively, and the difference was statistically significant （P 〈 0. 05）. Conclusion The combination of insulin glargine with acarbose and/or metformin is effective in controlling the blood glucose, decreasing the incidence of hypoglycemia,and controlling the body weight of senile obese type 2 diabetic patients.