胰岛素泵治疗重症高龄2型糖尿病患者临床分析

Clinical analysis of insulin pump therapy in elderly patients with severe type 2 diabetes

目的 比较胰岛素泵持续皮下输注胰岛素与多次皮下注射胰岛素对重症高龄2型糖尿病患者的疗效与安全性.方法 将37例在重症监护室（ICU）住院的重症高龄2型糖尿病患者按随机数字表法分为观察组（19例）和对照组（18例）,观察组用胰岛素泵持续皮下输注赖脯胰岛素,对照组用赖脯胰岛素三餐前及甘精胰岛素晚上睡前常规皮下注射,两组患者及家属均给予糖尿病教育、根据病情合适的糖尿病饮食,比较治疗前后两组患者的血糖变化、胰岛素用量、血糖控制达标时间、低血糖发生率及住院时间.结果 治疗后观察组空腹血糖为（7.2±1.2）mmo1/L,餐后2h血糖为（9.4±1.2） mmol/L,睡前血糖为（9.4±1.3） mmol/L,对照组分别为（8.5±3.0）、（10.0±2.4）、（10.2±2.4）mmol/L,治疗后两组患者空腹血糖、餐后2h血糖及睡前血糖均较治疗前显著下降,且两组治疗后比较差异有统计学意义（P＜0.05）.观察组患者血糖控制达标时间为（5.4±2.5）d,胰岛素用量为（43±9）U/d,而对照组分别为（12.8±3.8）d、（55±10）U/d,两组比较差异有统计学意义（P＜0.05）.观察组未见低血糖发生.结论 胰岛素泵持续皮下输注胰岛素与多次皮下注射胰岛素对重症高龄2型糖尿病均具有较好的疗效与安全性,且胰岛素泵持续皮下输注胰岛素更利于此类患者血糖控制及改善病情.

Objective To compare the clinical efficacy and safety of continuous subcutaneous insulin infusion （CSII） and multiple subcutaneous insulin injection （MSII） in elderly patients with severe type 2 diabetes.Methods Thirty-seven elderly patients with severe type 2 diabetes in the hospital intensive care unit （ICU） were divided into observation group （19 cases） and control group （18 cases） by random number table method.The observation group was treated with continuous subcutaneous insulin recombinant human insulin lispro injection,and control group was treated with recombinant human insulin lispro injection before meals and at bedtime routine insulin glargine subcutaneous injection.Two groups of patients and their families were given diabetes education.Changes in blood glucose,insulin dosage,blood glucose control standard time,rate of hypoglycemia and hospitalization time between 2 groups before and after treatment were compared.Results After treatment,fasting blood glucose in observation group was （7.2 ± 1.2） mmol/L,2 hour postprandial blood glucose was （9.4 ± 1.2） mmol/L,bedtime blood glucose was （9.4 ± 1.3） mmol/L; which in control group was （8.5 ± 3.0）,（10.0 ± 2.4）,（10.2 ± 2.4）mmol/L respectively.Fasting blood glucose,2 hour postprandial blood glucose and bedtime blood glucose significantly decreased after treatment in two groups,but there was significant difference between 2 groups （P 〈 0.05）.Blood glucose control standard time in observation group was （5.4 ± 2.5） d,insulin dosage was （43 ± 9） U/d,in control group was （12.8 ± 3.8） d,（55 ± 10） U/d respectively,and there was significant difference （P 〈 0.05）.Observation group had no hypoglycemia.Conclusion CSII for elderly patients with severe type 2 diabetes has better curative effect and security than MSII,and is more conducive to the control of blood glucose and the improvement of the condition.