应用动态血糖监测系统评价地特胰岛素作为基础胰岛素治疗的优越性

Superiority of detemir as basal insulin replacement evaluated by continuous glucose monitoring system

目的采用动态血糖监测(CGMS)系统观察口服降糖药控制不佳的T2DM患者加用地特胰岛素治疗的优越性。方法 68例使用口服降糖药血糖控制不佳的T2DM患者,按1∶1随机分为睡前加用地特胰岛素组(Det组)和中性鱼精蛋白锌胰岛素组(NPH组),治疗12周。结果治疗12周后,两组HbA1c、FPG均较基线下降,但两组间差异无统计学意义(P>0.05)。Det组血糖值标准差、FPG标准差、睡前血糖标准差、日间血糖平均绝对差均明显低于NPH组(P<0.05,P<0.01)。Det组低血糖发生率(11.8%)显著低于NPH组(23.5%)(P<0.05)。结论使用口服降糖药血糖控制不佳的T2DM患者,联合地特胰岛素对比联合NPH治疗,在FPG和HbA1c同样达到较好控制的同时,经CGMS证实,地特胰岛素治疗一日内和一日间血糖波动小,低血糖发生率低。

Objective To evaluate the superiority of detemir as basal insulin treatment by continu- ous glucose monitoring system （CGMS） in T2DM patients. Methods Six-eight T2DM patients who had poorly controlled blood glucose by oral hypoglycemic agents（OHA） agents were randomized into the insu- lin detemir （Det）group （n=34） and neutral protamine hagedorn （NPH） group （n=34）. They were trea- ted once daily at bedtime for 12 weeks. Results After twelve weeks, the HbAlc and FPG were de- creased in both groups, but there was no statistical difference in the comparison between the two groups （P〉0. 05）. In the Det group, the standard deviations （SD） of blood glucose, FPG and blood glucose at bedtime, and absolute means of daily differences （MODD） were significantly lower than those in the NPH group respectively （P〈0. 05, P〈0.01）. The incidence of hypoglycemia episode in the Det group（11.8 %） was significantly lower than in the NPH group （23.5 %） （P〈0.05）. Conclusions The treatment with detemir as basal insulin is superior to NPH in glycemia and HbA1 c control, with less daytime glucose fluc- tuation and hypoglycemia episode in OHA poorly controlled T2DM patients.