胰岛素泵治疗血糖控制不佳2型糖尿病的临床研究

Insulin pump treating poor glucose control patients with type 2 diabetes mellitus

目的评价胰岛素泵治疗血糖控制不佳2型糖尿病的有效性和安全性。方法2013年1—3月期间选择血糖控制不佳的2型糖尿病患者100例作为研究对象，采用随机数字表将100例患者分为观察组和对照组，各50例，观察组患者给予胰岛素泵进行强化治疗，而对照组患者采用多次胰岛素皮下注射治疗。治疗结束后，比较2组患者治疗前、后6个时点（早餐前、三餐后、睡前和凌晨3∶00）的血糖、住院时间、胰岛素用量及低血糖发生率。结果治疗前2组患者各时间点的血糖差异无统计学意义（P〉0.05）；治疗结束后，2组患者的血糖均明显低于治疗前，差异有统计学意义[对照组早餐前为（6.9±1.3）mmol/L比（14.2±3.4）mmol/L，早餐后2 h为（7.4±1.7）mmol/L比（18.9±2.9）mmol/L，午餐后2 h为（8.2±1.6）mmol/L比（16.5±3.4）mmol/L，晚餐后2 h为（8.6±1.8）mmol/L比（16.4±3.8）mmol/L，睡前为（8.3±1.5）mmol/L比（12.4±2.2）mmol/L，凌晨3∶00为（7.8±1.5）mmol/L比（8.9±3.2）；观察组早餐前为（6.0±1.2）mmol/L比（14.3±3.2）mmol/L，早餐后2 h为（6.6±1.5）mmol/L比（18.0±4.8）mmol/L，午餐后2 h为（7.1±1.4）mmol/L比（16.9±4.5）mmol/L，晚餐后2 h为（7.5±1.6）mmol/L比（16.2±3.7）mmol/L，睡前为（7.2±1.3）mmol/L比（12.2±2.6）mmol/L，凌晨3∶00为（6.6±1.1）mmol/L比（9.9±1.5）,均P〈0.01]。血糖达标时，观察组患者胰岛素平均使用量为（43.9±3.6）U/d，低于对照组的（55.8±3.8）U/d;观察组患者平均住院时间为（7.1±2.1）d，低于对照组的（14.2±3.3）d;观察组患者治疗期间低血糖发生率为6.0%（3/50），低于对照组的32.0%（16/50）,差异均有统计学意义（均P〈0.01）。结论胰岛素泵和多次胰岛素皮下注射治疗血糖控制不佳的2型糖尿病患者均有效果，但胰岛素泵比多次胰岛素皮下注射更加安全、有效。

ObjectiveTo assess the efficacy and safety of insulin pump therapy treating poor glucose control patients with type 2 diabetes mellitus（T2DM）. Methods Totally 100 poor glucose control patients with T2DM were selected. A randomized and multiple insulin injectioncontrolled study was performed. T2DM patients were randomly assigned into oberstivation group（n=50） and control group（n=50）. Patients in observation group received insulin pump therapy, while patient in control group received the treatment of multiple subcutaneous insulin injection. The blood glucose at six time points, hospitalization days, average insulin dose and incidence of hypoglycemia were compared. Results No significant differences of blood glucose between groups were observed （P〈0.05） at baseline. After intensive therapy, the fasting bloodglucose was significantly decreased in both groups （before treatment, before breakfast, 2 h after breakfast, 2 h after lunch, after dinner for 2 h before bedtime, 3∶00 am blood glucose in control group were 14.2±3.4,18.9±2.9,16.5±3.4,16.4±3.8,12.4±2.2,8.9±3.2 mmol/L;after treatment was 6.9±1.3,7.4±1.7,8.2±1.6,8.6±1.8,8.3±1.5,7.8±1.5 mmol/L;before treatment, before breakfast, 2 h after breakfast, 2 h after lunch, after dinner for 2 h before bedtime, 3∶00 am blood glucose inobservation group were 14.3±3.2,18.0±4.8,16.9±4.5,16.2±3.7,12.2±2.6,9.9±1.5 mmol/L;after treatment was 6.0±1.2,6.6±1.5,7.1±1.4,7.5±1.6,7.2±1.3,6.6±1.1 mmol/L;all P〈0.01）. The average consumption of insulin per day was （43.9±3.6）U/d in observation group, significantly lower than that in control group （P〈0.001）. The hospitalization time was （7.1±2.1）days in observation group, statistically significant lower than that in control group （P〈0.01）; the incidence of hypoglycemia in observation group was 6.0%（3/50）, statistically lower than that in control group （P〈0.01）. Conclusion Both insulin pump and multiple subcutaneous insulin injection are effective in blood glucose control among T2DM patients with poor glucose control.