不同方案胰岛素强化治疗2型糖尿病的临床效果观察

Clinical observation of different intensive insulin therapy in the treatment of type 2 diabetes mellitus T2DM

目的对比不同胰岛素强化治疗方案治疗2型糖尿病(T2DM)的临床效果。方法 126例T2DM患者随机分为A、B、C三组,A组患者给予门冬胰岛素以胰岛素泵强化治疗,B组患者每日三餐前予以门冬胰岛素+睡前甘精胰岛素皮下注射治疗,C组患者三餐前予以门冬胰岛素30皮下注射治疗,对比三组患者治疗前后空腹血糖(FPG)、餐后2小时血糖(2h PG)、糖化血红蛋白(Hb A1c)水平、胰岛素抵抗指数(HOMA-IR)以及三组患者血糖达标时间、胰岛素用量及低血糖发生率。结果三组患者治疗前FPG、2h PG水平比较差异均无显著性(P>0.05);治疗后FPG及2h PG水平均较治疗前显著降低,A组低于B、C组(P<0.05)。三组患者治疗前Hb A1c、HOMA-IR比较差异均无显著性(P>0.05),治疗后上述指标较治疗前均显著降低(P<0.05),但三组间比较差异均无显著性(P>0.05)。三组患者血糖达标时间及胰岛素用量比较差异均具有显著性(P<0.01)。三组间低血糖发生率比较差异无显著性(χ2=0.392,P=0.072)。结论门冬胰岛素基础剂量与餐前剂量1︰1注射的胰岛素泵强化治疗方案能够更加迅速地控制血糖水平达标,减少胰岛素用量,值得临床推广应用。

ObjectiveTo discuss the clinical effects of different intensive insulin therapy in the treatment of type 2 diabetes mellitus （T2DM）.Method126 patients with T2DM were randomly divided into group A, B and C. Group A patients were treated with intensive therapy of insulin aspart with insulin pump, group B patients were treated with insulin aspart＋ bedtime insulin glargine subcutaneous injection therapy daily, group C patients were treated with insulin aspart 30 subcutaneous injection daily before meals, FPG, 2hPG, HbA1c and HOMA-IR were contrasted among the three groups before and after treatment, and standard time of blood glucose, insulin dosage of maintain blood glucose and incidence of hypoglycemia were contrasted among the three groups.ResultThere were no signiifcant differences in FPG and 2hPG among the three groups before treatment （P〉0.05）, levels of FPG and HbA1c after treatment were signiifcantly lower than before treatment, and the levels of FPG and 2hPG in group A were lower than group B and group C （P〈0.05）. There was no signiifcant difference of HbA1c and HOMA-IR among the three groups before treatment （P〉0.05）, but after treatment, the above indexes were sighiifcantly lower than before treatment among the three groups （P〈0.05）, there were no signiifcant differences after treatment among the three groups （P〉0.05）. There were signiifcant differences in standard time of the blood glucose and insulin dosage among the three groups （P〈0.05）. There was no signiifcant difference in incidence of hypoglycemia among the three groups （χ^2=0.392,P=0.072）.ConclusionInsulin pump intensive therapy with aspart insulin dose and basal dose and pre-meal dose 1︰1 can more quickly control the blood glucose level to the target value, and can reduce the dosage of insulin in the treatment of patients with T2DM, worthy of promotion.