胰岛素3种强化治疗方案的疗效及安全性比较

Comparison of Curative Effects and Safeties among Three Types of Insulin Intensive Treatment Program

目的比较基础+餐时人胰岛素、基础+餐时胰岛素类似物及胰岛素类似物泵3种胰岛素强化治疗方案对2型糖尿病患者血糖控制的有效性及安全性。方法将120例2型糖尿病患者随机分为A,B,C 3组,A组(n=60)采用诺和平+诺和锐于睡前及三餐时皮下注射,B组(n=60)采用诺和锐泵持续24 h皮下泵入,C组(n=60)采用诺和灵N+诺和灵R,于睡前及三餐前30 min皮下注射,并在治疗达标后观察三餐前及睡前指尖血糖、糖化血红蛋白、72 h动态血糖变化、患者低血糖发生率及体重变化。结果A组在患者血糖控制水平、糖化血红蛋白达标率、72 h动态血糖波动、低血糖发生率及体重变化方面与B组和C组比较差异有统计学意义(P<0.05)。结论诺和平+诺和锐胰岛素强化治疗方案对2型糖尿病血糖水平控制长效而稳定,不易引起低血糖反应发生,引起体重增加量少。

Objective To compare the curative effects and safeties among three types of intensive insulin therapy program including basic plus meal human insulin,basic plus meal insulin analogues and insulin analogue pump in treating the patients with type 2 diabetes mellitus（T2DM）.Methods 120 cases of T2DM were randomly divided into the group A,B and C.The group A（n=60） was given levemir plus novorapid by subcutaneous injection before three meals and before sleep,the group B（n=60） adopted the novorapid pump by subcutaneous injection for continuing 24 h and the C group（n=60） adopted novolin N plus novolin R by subcutaneous injection at 30 min before three meals and before sleep.The blood glucose,glycosylated hemoglobin（HbA1c） and 72 h dynamic blood glocose change at the finger tip before three meals and before sleep after reaching the treatment standard were observed.Futhermore,the incidence rate of hypoglycemia and the change of the body weight were investigated.Results The blood glucose level control,reaching standard rate of HbA1c,the fluctuation scope of blood glucose within 72 h,the incidence rate of hypoglycemia and the body weight fluctuation in the group A showed statistical significant difference compared with the group B and C（P 〈0.0）.Conclusion The intensive insulin therapy program of levemir plus novorapid has the long-term and stable curative effect with little body weight increment for controlling blood glucose in T2DM and is uneasy to cause the occurrrence of hypoglycemia.