地特胰岛素与中性鱼精蛋白锌胰岛素联合诺和龙对新诊断2型糖尿病患者血糖变异性影响的观察

Effects of insulin determir versus NPH combined with repaglinide on glycemic variability in newly diagnosed T2DM patients

目的观察地特胰岛素或中性鱼精蛋白锌胰岛素(NPH)联合诺和龙治疗对新诊断T2DM患者血糖水平及其变异性的影响。方法将100例新诊断T2DM病患者随机分为两组,各50例,即地特胰岛素联合诺和龙治疗(A)组与NPH联合诺和龙治疗(B)组。治疗3个月后,采用动态血糖监测(CGMS)系统进行连续72h的血糖监测,监测数值864个。观察平均血糖水平、一日内血糖最高值及最低值、血糖漂移最大幅度、血糖3.6～8.0mmol/L所占一日内时间百分比。结果 (1)治疗3个月后,两组FBG、2hBG和HbA1c均降低,差异有统计学意义(P<0.05或P<0.01);而FBG、2hBG和HbA1c水平两组间比较差异无统计学意义(P>0.05);(2)CGMS结果显示,两组间平均血糖水平差异无统计学意义[(7.2±1.4)vs(7.3±1.6)mmol/L,P>0.05],但A组一日内血糖最高值、一日内血糖漂移最大幅度均低于B组[(9.2±2.0)vs(12.5±1.8)mmol/L,(5.8±1.6)vs(9.8±1.3)mmol/L],A组血糖3.6～8.0mmol/L所占一日内时间百分比高于B组[(82.4±6.5)%vs(73.1±9.4)%],差异有统计学意义(P<0.01)。A组低血糖发生率低于B组(12%vs 34%,P<0.05)。结论地特胰岛素在改善T2DM患者血糖变异性方面优于NPH。

Objective To compare the effects of insulin Determir and NPH combined with repaglinide on glucose variability in newly diagnosed T2DM patients. Methods A total of 100 patients with newly diagnosed T2DM were randomized into two groups with 50 in each., one group （group A, Determir group） was treated with insulin Determir combined with repaglinide and the other （group ]3, NPH group） with NPH combined with repaglinide. After 3 months＇ treatment, the dynamic glycemia monitoring system （COMS）was used for 72 h and 864 times of blood glucose were recorded. The average glucose levels, intraday highest and lowest glycemia, maximum amplitude of glycemic excursion, the average levels of pre- and post-prandial glycemia, and the percentage of glycemia drift accounted for intraday time were observed. Results （1） After 3 months＇ treatment, the FBG, 2 ht1, and HbAlc of both groups had a significant decrease in statistics （P〈0. 05 or P〈0. 01）, while the levels of FBG, 2 hBG, and HbAlc were not statistically different between the two groups （P〉0. 05）. （2） The C__^-MS results showed that there was no significant difference in average glycemia levels between the two groups [-（7. 2=kl. 4） vs （7.3il. 6）retool/L, P^0. 051. However, the intraday highest glycemia and maximum amplitude of glycemic excursion were lower in the Determir group than in the NPH group [-（9.2±2. 0） vs （12. 5±. 8）mmol/L, （5.8il. 6） vs （9.8±1.3）mmol/L]. The percentage of glycemia drift between 3.6-8. 0 mmol/L accounted for the intraday time was significantly higher in the Determir group than in the NPH group （P〈0. 05）. And the incidence of hypoglycemia in the Determir group was lower than that in the NPH group （12%vs 34%, P〈0. 05）. Conclusion Insulin determir improves glycemia variability better than NPH.