2型糖尿病患者口服降血糖药失效后起始胰岛素治疗方案的选择

The choice of initial insulin treatment plan for type 2 diabetes mellitus patients with failure of oral hypoglycemic agents

目的探讨2型糖尿病患者口服降血糖药失效后的胰岛素治疗方案。方法选择180例口服降糖药失效的2型糖尿病患者按数字表法随机分为三组：A组（60例，甘精胰岛素组）、B组（60例，门冬胰岛素30组）和c组（60例，甘精胰岛素＋门冬胰岛素组）。24周后观察降糖疗效和安全性。3年后观察研究对象对三种治疗方案的依从性和长期疗效。结果24周后，三组HbAlc水平与研究前比较均明显降低[A组：（7．3±0．8）％比（10．2±1．7）％；B组：（7．0±0．8）％比（9．9±1．5）％；C组：（6．9±0．7）％比（10．4±1．8）％，均P〈0．05]。低血糖的发生率A组1．04次·年-1·例-1，B组1．31次·年-1·例-1，c组1．66次·年-1·例-1，c组明显高于其它两组（x2=11．777、4．362，均P〈0．05）。每天平均降糖药物费用A组：（25．6±3．8）元，B组：（12．9±3．0）元，c组：（22．7±4．7）元，B组明显低于A组和c组（t=18．943、13．226，均P〈0．05）。3年后继续使用原治疗方案的患者比例，A组：68．0％，B组：73．0％，C组：40．0％。C组明显少于A组和B组（x2=8．656、12．398，均P〈0．05）。结论对于口服降血糖药失效的2型糖尿病患者，可根据自身的经济条件，选用门冬胰岛素30或甘精胰岛素。门冬胰岛素30的长期疗效好，降血糖费用较低，患者依从性好，低血糖发生率低。

Objective To investigate the insulin treatment plan after the failure of oral hypoglycemic agents for type 2 diabetes in China. Methods 180 patients with type 2 diabetes who failed to oral hypoglycemic drugs were randomly divided into three groups on average： A group （ insulin glargine ± metformin ± gliclazide sustained - release tablets ） , B group （ insulin aspart 3 0 ± mefformin ） and C group （ insulin glargine ± metformin ± insulin aspart ） .24 weeks later, the hypoglycemic effect and security were observed. Three years later, the compliance that patients used original treatment plan were observed. Results 24 weeks later, HbA1 c of the three group significantly decreased compared with that before the study[A group：（7.3 ±0.8）% vs. （10.2 ±1.7）% ;B group：（7.0 ±0.8）% vs. （9.9 ± 1.5 ） % ; C group： （ 6.9 ± 0.7 ） % vs. （ 10.4 ± 1.8 ） %, all P 〈 0.05 ]. The incidence of hypoglycemia in C group （ 1.66 times · year-1 · people- 1 ） was significantly higher than that in A group （ 1.04 times · year- 1 · people-1 ） and B group （ 1.31 times · year-1 · people- 1 ） （ X2 = 11. 777,4. 362, all P 〈 0.05 ）. However, the daily average cost of the drug in the B group [ （12.9 ± 3.0）yuan ] was significantly lower than that in A group [ （25.6 ± 3.8 ）yuan ] and C group [ （22.7 ± 4.7） yuan ] （ t = 18. 943,13. 226, all P 〈 0.05 ）. Three years later, the percentage of patients who used original treatment plan in the C group（40.0% ） was significantly less than that in A group（68.0% ） and B group （73.0%） （ x2 = 8. 656,12.398, all P 〈 0. 05 ）. Conclusion Type 2 diabetic patients who failed to oral hypoglycemic agents, according to their own economic conditions, might choose aspart 30 or glargine. The hypoglycemic treatment of aspart 30 has better long term effect,lower costs and incidence of hypoglycemia,better compliance.