不同血糖检测方式联合胰岛素强化治疗降糖效果比较

Observation of Glucose-Lowering Effect by Using Different Blood Glucose Monitoring Combined with Intensive Insulin Therapies in Diabetic Patients

目的探讨糖尿病患者不同血糖检测联合不同胰岛素强化治疗方法的降糖效果,寻找最佳降糖方案。方法选择使用胰岛素强化治疗的糖尿病患者119例,根据血糖监测联合胰岛素强化治疗方法将其随机分为3组。采用实时动态血糖监测系统(CGMS)、胰岛素泵持续皮下输注系统(CSII)及监护(Care Link软件)联合治疗的39例为3C组;采用CSII强化治疗,以用指尖末梢血糖监测的40例为CSII组;采用每天多次胰岛素注射(MDI)强化治疗,应用CGMS监测血糖的40例为MDI组。观察各组平均血糖(MBG)、平均血糖波动幅度(MAGE)、低血糖尤其是无症状性低血糖(HUN)的情况及糖化血红蛋白(Hb A1C)的变化。结果与治疗前相比,3组治疗后MBG和Hb A1C均明显下降(P<0.05);与MDI组相比,3C组及CSII组下降水平更明显(P<0.05),但与3C组相比,CSII组下降水平不明显(P>0.05)。3C组MAGE显著低于CSII组及MDI组(P<0.01),而后两组间MAGE变化不明显(P>0.05);与MDI组相比,3C组出现低血糖的次数显著减少(P<0.01);与CSII组相比,3C组发现低血糖尤其HUN例次显著增加(P<0.05)。结论频繁指尖血糖监测仍有绝大多数的低血糖未被发现,尤其是HUN;在相同检测条件下,胰岛素泵治疗及精细调控情况比分次胰岛素注射效果好;动态血糖监测联合胰岛素泵治疗,能显著减少血糖波动,减少低血糖的发生率,为最佳降糖方案。

Objective To compare the hypoglycemic effect of different blood glucose monitoring combined with different intensive insulin therapies for seeking the optimal glucose-lowering scheme by observing the glucose-lowering effect using different blood glucose detection combined with different intensive insulin therapies in the diabetic patients. Methods 119 diabetic patients with intensive insulin therapy were selected and randomly divided into three groups according to the blood glucose monitoring combined with the intensive insulin therapeutical method. 39 cases receiving the combined therapy of the real time continuous glucose monitoring system（ CGMS,Guardian @ RT）, pump continuous subcutaneous insulin infusion system（ CSII） and monitoring（ Care Link software） as the 3 C group,40 cases treated by the CSII intensive treatment and fingertips peripheral blood glucose monitoring as the CSII group and 40 cases by using the intensive therapy of several times of insulin injection per day（ MDI） and monitoring blood glucose levels by CGMS as the MDI group. The mean blood glucose（ MBG）,mean amplitude of glycemic excursions（ MAGE）,hypoglycemia especially asymptomatic hypoglycemia（ HUN） and glycated hemoglobin（ Hb A1C） changes in each group were observed. Results Compared with before treatment,MBG and Hb A1 C after treatment were significantly decreased（ P 0. 05）, and compared with the MDI group, the descent levels in the3 C group and the CSII group were more obvious（ P 0. 05）,but compared with the 3C group,the descent level in the CSII group were not obvious（ P 0. 05）; MAGE in the 3C group was significantly lower than that in the CSII group and MDI group（ P 0. 01）,but the MAGE change between the CSII group and MDI group was not significantly（ P 0. 05）; compared with the MDI group,the times of hypoglycemia occurrence in the 3C group was significantly reduced（ P 0. 01）, compared with the CSII group, hypoglycemia especially HUN in the 3C group was significantly increased（ P 0. 05）. Conclusion The vast majority of hypoglycemia,especially HUN,have not been found in frequent fingertips blood glucose monitoring; in the same detection situation,the insulin pump therapy and the fine regulation situation have better effect than the multiple insulin injections; the dynamic glucose monitoring combined with the insulin pump therapy could significantly reduce the blood glucose fluctuations and the occurrence rate of hypoglycemia,which may be the best scheme for reducing blood sugar.