地特胰岛素对2型糖尿病患者体质量影响的临床观察

Clinical Observation of the Effect of Levemir on theBody Mass of Type 2 Diabetes Patients

目的观察口服磺脲类失效的2型糖尿病患者起始地特胰岛素后对患者体质量的影响。方法选择2011年1月至2012年12月在西安交通大学附属三二○一医院内分泌科门诊就诊的既往口服磺脲类治疗效果不佳而未曾接受胰岛素治疗的2型糖尿病患者66例,以体质量指数(BMI)作为患者体质量的评估标准将患者分为3组:BMI<24 kg/m2者为A组(20例);24 kg/m2≤BMI<28kg/m2者为B组(22例);BMI≥28 kg/m2者为C组(24例)。三组均给予地特胰岛素治疗,起始剂量为0.2 U/(Kg·d)。分别测定并比较各组患者治疗前后空腹血糖(FPG)、糖化血红蛋白(HbA1c)、BMI及胰岛素用量。结果治疗后A、B、C组FPG值均较治疗前显著降低[(5.08±0.38)mmol/L vs(14.07±1.22)mmol/L、(5.03±0.39)mmol/L vs(14.01±1.20)mmol/L、(4.9±0.47)mmol/L vs(13.52±1.49)mmol/L,均P<0.05)],三组间治疗前无显著差异(P>0.05),治疗后C组与A组间比较差异有统计学意义(P<0.05),C组降低最显著;治疗后HbA1c值A、B、C组均较治疗前显著降低[(5.52±0.40)%vs(8.46±0.48)%、(5.48±0.38)%vs(8.28±0.60)%、(5.54±0.37)%vs(8.36±0.58)%,均P<0.05];治疗前后BMI仅C组差异有统计学意义,治疗前和治疗后三组间比较差异均有统计学意义(P<0.05),分别为C组>B组>A组。三组间地特胰岛素用量比较差异有统计学意义,A、B组比较差异无统计学意义(P>0.05),C组药物剂量[(18.88±2.66)U]显著高于A、B两组[(13.45±1.47)U、(14.73±1.42)U,均P<0.05]。结论口服磺脲类失效的患者起始地特胰岛素治疗,可有效降低不同BMI的2型糖尿病患者血糖,同时患者体质量无显著增加,肥胖患者体质量有一定程度的降低。

Objective To observe the effect of levemir on body mass of type 2 diabetes patients who had OAD failure （sulfonylureas） and not been treated with insulin before.Methods A total of 66 cases of type 2 diabetes patients,who had OAD failure（sulfonylureas） and without insulin therapy before,admitted in No.3201 Hospital Affiliated to Xi＇an Jiaotong University from Jan.2011 to Dec.2012 were divided into three groups according to their body mass index（BMI）：BMI 〈24 kg/m^2 as group A （20 cases） ;24 kg/m^2 ≤BMI 〈28 kg/m^2 as group B （22 cases） ;BMI≥28 kg/m^2 as group C （24 cases）.Patients in all of the three groups were given insulin levemir therapy,with the starting dose of 0.2 U/（kg · d）.The levels of fasting plasma glucose （FPG）,glycated hemoglobin （HbA1c）,BMI before and after treatment and insulin dosage of the three groups were analyzed.Results After treatment,FPG values of group A,B,C were all significantly lower than those before treatment [（5.08 ± 0.38） mmol/L vs （14.07 ± 1.22） rmtmol/L,（5.03 ± 0.39） mmol/L vs （14.01 ±1.20） rmtmol/L,（4.9 ±0.47） mmol/L vs （13.52±1.49） mmol/L,P〈0.05）],there were no statistically significant differences among the values of the three groups before treatment （P 〉 0.05）,while there was statistically significant difference between the values of group C and group A after treatment（P 〈 0.05）,and the value of group C reduced the most significantly.After treatment,HbA1c values of group A,B,C were significantly lower than those before treatment [（5.52 ± 0.40） % vs （8.46 ± 0.48）%,（5.48 ±0.38）% vs （8.28 ±0.60）%,（5.54 ±0.37）% vs （8.36 ±0.58）%,P 〈 0.05].There was statistically significant difference of BMI before and after treatment only in group C ; and there were statistically significant differences of BMI between either two groups of the three before and after treatment（P 〈0.05）,and BMI of group C 〉 group B 〉 group A.There were also statistically significant differences of insulin dosage among the three groups,while the difference between group A and group B was not statistically significant （P 〉 0.05）,insulin dosage of group C [（18.88 ± 2.66） U] was significantly higher than group A and group B [（13.45 ± 1.47） U,（14.73 ± 1.42） U,both P 〈 0.05].Conclusion Initiating levemir therapy for patientswith OAD failure（sulfonylurea） can effectively reduce the levels of blood sugar in type 2 diabetes patients with different BMI,with no significant increase to their body mass,while the body mass of obese patients has some degree of decrease.