住院2型糖尿病患者降糖方案的优选试验

Selection Test of Hypoglycemic Scenario for Inpatients with Type 2 Diabetes

目的运用动态血糖监测仪观察分析临床常用的4种降糖方案的血糖波动情况、疗效、安全性。方法将120例住院2型糖尿病患者分为A组(格列美脲和三餐阿卡波糖组)30例、B组(瑞格列奈和二甲双胍组)30例、C组(诺和灵30R早晚皮下注射组)30例、D组(甘精胰岛素和三餐前门冬胰岛素皮下注射组)30例,均进行72h动态血糖监测。结果各组患者性别、年龄、病程、BMI、HbA1C比较,差异均无统计学意义(P>0.05)。各组平均血糖值无明显差异(P>0.05);A组高血糖时间比率、血糖波动系数较D组明显增加(P<0.01);B组的餐后时段血糖、低血糖时间比率控制显著优于A组(P<0.05);C组的平均空腹血糖值、平均中餐后血糖、高血糖时间比率、血糖波动系数显著高于A、B、D各组(P<0.05);低血糖的发生率由B、A、D、C组依次升高,C组低血糖时间比率最高,与A、B、D各组比较差异均有统计学意义(均P<0.05)。结论动态血糖监测系统可以较准确地监测血糖和评价血糖漂移等波动指标,并评估降糖方案的疗效和安全性。HbA1C达标、血糖波动较小的治疗方案应被优先选择。选择一种适宜糖尿病患者个体化降糖方案的同时联合动态血糖监测,是目前较理想的糖尿病治疗途径。

Objective To analyze the efficacy and safety of four hypoglycemic programs using a continuous glucose monitor.Methods A total of 120 inpatients with type 2 diabetes were treated with glimepiride plus acarbose（group A,n=30）,glimepiride plus metformin（group B,n=30）,subcutaneous injection of Novolin 30R in the morning and evening（group C,n=30）,or insulin glargine plus preprandial subcutaneous injection of insulin aspart（group D,n=30）.Continuous glucose monitoring was performed in all patients.Results There were no significant differences in the gender,age,disease course,body mass index,HbA1C levels and mean blood glucose values among the four groups（P0.05）.Compared with group D,time ratio for hyperglycemia and blood glucose fluctuation coefficient significantly increased in group A（P0.01）.Compared with groups A,postprandial blood glucose levels and time ratio for hypoglycemia were obviously improved in group B（P0.05）.Compared with group C,average fasting blood glucose values,mean postprandial blood glucose values,time ratio for hyperglycemia and blood glucose fluctuation coefficient significantly decreased in group A,B,and D（P0.05）.The incidence of hypoglycemia increased successively in group B,A,D and C.Compared with group C,time ratio for hypoglycemia significantly decreased in group A,B,and D（P0.05）.Conclusion Continuous glucose monitoring system can accurately monitor blood glucose fluctuations,evaluate blood glucose excursions and assess the efficacy and safety of hypoglycemic programs.Treatment program resulting in standard HbA1C levels and small fluctuations in blood glucose should be should be preferred.Individualized hypoglycemic program combined with continuous glucose monitoring is an ideal method for the treatment of diabetes.