不同时间注射甘精胰岛素治疗1型糖尿病的安全性及疗效评价

EVALUATION ON SAFETY AND EFFECTIVENESS ABOUT INSULIN GLARGINE INJECTION AT DIFFERENT TIME IN PATIENTS WITH TYPE 1 DIABETES MELLITUS

目的观察不同时间皮下注射甘精胰岛素治疗1型糖尿病患者的安全性和有效性。方法收集36例1型糖尿病患者资料,12例患者采用甘精胰岛素联合生物合成人胰岛素治疗,24例患者采用甘精胰岛素联合门冬胰岛素治疗。将甘精胰岛素由22:00更改为18:00皮下注射,比较更改注射时间前后3d患者的空腹血糖(fasting blood-glucose,FBG)、餐后2h血糖(2-hours post meal blood-glucose,2hPBG)、午餐前血糖以及三餐前胰岛素和甘精胰岛素用量。结果更改注射时间后,甘精胰岛素联合生物合成人胰岛素治疗的患者FBG和午2hPBG显著下降(P<0.05);午餐前中度低血糖(血糖≤2.8mmol/L)事件发生减少,血糖达到理想水平(P<0.05);午餐前轻度低血糖(血糖≤3.9mmol/L)事件发生差异无统计学意义(P>0.05)。更改注射时间后,甘精胰岛素联合门冬胰岛素治疗的患者FBG和午2hPBG亦显著下降(P<0.01,P<0.05);午餐前轻度低血糖(血糖≤3.9mmol/L)事件及中度低血糖(血糖≤2.8mmol/L)事件发生均显著减少(P<0.01)。结论将1型糖尿病患者甘精胰岛素的注射时间由常规的22:00提前到18:00,可以在不增加胰岛素用量的情况下,简单方便地实现快速平稳降糖。

Objective To evaluate the safety and the effectiveness about subcutaneous injection of insulin glargine at different time in patients with type 1 diabetes mellitus.Methods Clinical data about 36 inpatients with type 1 diabetes from our hospital were collected.Twelve patients were treated with insulin glargine combined with biosynthetic human insulin,and the remaining 24 patients were treated with insulin glargine combined with insulin aspart.Subcutaneous injection time of insulin glargine was changed from 22：00 to 18：00.Observation was made in fast blood glucose（FBG）,postprandial 2h blood glucose （2hPBG）,blood glucose before lunch,the doses of biosynthetic human insulin or insulin aspart and insulin glargine during 3 days before and after variation of injection time.Results In the patients treated with insulin glargine combined with biosynthetic human insulin,compared with before variation of injection time,FBG and lunch 2hPBG were decreased （P ＜ 0.05）,moderate hypoglycemia （blood glucoses≤2.8 mmol/L） incidents before lunch were significantly reduced （P ＜0.05）.There was no significant difference in conventional hypoglycemia （blood glucose ≤ 3.9 mmol/L） incidents before lunch （P ＞ 0.05）.In the patients treated with insulin glargine combined with insulin aspart,compared with before variation of injection time,FBG and lunch 2hPBG were decreased （P ＜ 0.05,P ＜ 0.01）.Conventional hypoglycemia （blood glucoses≤3.9 mmol/L） incidents and moderate hypoglycemia （blood glucoses≤2.8 mmol/L） incidents before lunch were significantly reduced （P ＜0.01）.There were no significant differences in breakfast and supper 2hPBG,the doses of biosynthetic human insulin or insulin aspart and insulin glargine （P ＞ 0.05）.Conclusion The result suggests that variation of insulin glargine injection time from 22：00 to 18：00 can stabilize rapidly blood glucose in patients with type 1 diabetes mellitus,even without increasing the doses of insulin.