甘精胰岛素与预混胰岛素联合瑞格列奈治疗2型糖尿病的疗效及安全性评价

Evaluation on effects and safety of glargine or premixed insulin combined with repaglinide in treating type Ⅱ diabetes mellitus

目的探讨甘精胰岛素或预混胰岛素联合瑞格列奈对2型糖尿病的疗效及安全性。方法选取2014年12月至2015年12月该院收诊治疗的86例2型糖尿病患者作为研究对象,按照随机数字表分为Ⅰ组43例和Ⅱ组43例。Ⅰ组给予甘精胰岛素,于睡前皮下注射,初始剂量12U/d,同时联合瑞格列奈胰岛素促泌剂诺和龙,餐前口服1mg;Ⅱ组给予预混胰岛素诺和锐30R初始剂量6U,分别于早、晚餐前30min皮下注射,联合瑞格列奈胰岛素促泌剂诺和龙,餐前口服1mg。两组患者每周监测1次餐前、餐后2h及睡前共7个时间点血糖,受试者根据血糖水平调整胰岛素剂量,调整范围2~4U。每月随访1次,连续随访6个月。结果治疗后两组患者空腹血糖(FBG)、餐后2h血糖(2hPBG)、糖化血红蛋白(HbA1c)均降低,治疗3个月、6个月Ⅰ组FBG、2hPBG、HbA1c水平与同时段Ⅱ组比较,差异有统计学意义(P<0.05);治疗后Ⅰ组心理、生理、依从性、社会关系及自身影响评分均低于Ⅱ组,差异有统计学意义(P<0.05);治疗后Ⅰ组症状性低血糖发生率、轻微低血糖发生率、夜间低血糖事件、低血糖昏迷及心脑血管事件发生情况明显低于Ⅱ组(P<0.05)。结论甘精胰岛素联合瑞格列奈对2型糖尿病的疗效显著,有效控制血糖水平,提高生活质量和依从性,安全可靠,值得临床推广应用。

Objective To investigate the effect and safety of glargine or premixed insulin combined with repaglinide in treating type Ⅱ diabetes mellitus（T2DM）. Methods A total of 86 cases of T2DM treated in our hospital from December 2014 to December 2015 were selected as the research subjects and divided into the group I （43 cases） and group Ⅱ （39 cases） according to the random number table. The group I was given glargine （subcutaneous injection with an initial dose of 12 U/d before sleep） and simultane-ously combined with repaglinide insulin secretagogue novonorm （oral 1 mg before each mead）. The group ]I was given premixed in- sulin aspart 30 R （subcutaneous with an initial dose of 6 U at 30 rain before breakfast and dinner） and combined with repaglinide in- sulin secretagogue novonorm（oral 1 mg before each meal）. The blood glucose was monitored at 7 time points of before meal, past- prandial 2 h and before sleep in the two groups. Insulin dose was adjusted according to blood glucose level of the subjects, and the adjustment range was 2-4 U. All patients were followed up once a month and followed up lasted for 6 consecutive months. Results After treatment, the levels of fasting blood glucose（FPG）, 2 h PBG and glycosylated hemoglobin （HbAlc） in the two groups were all decreased, and the levels of FPG, 2 h PBG and HbAlc after 3-month,6-month treatment had statistical differences in the same time period between the group Ⅰ and Ⅱ （P〈0.05）; the scores of psychology, physiologiy, compliance, social relations and their own influence after treatment in the group Ⅰ were lower than those in the group Ⅱ （P〈0.05）; the symptomatic hypoglycemia incidence, mild hypoglycemia, nocturnal hypoglycemia event, hypoglycemic coma and cardiocerebrovascular events in the group Ⅰ were significantly lower than those in the group Ⅱ （P〈0.05）. Conclusion Glargine combined with repaglinide could obtain significant efficacy in treating T2DM, which could effectively control the blood sugar level, improves the quality of life and compliance, is safe and reliable and is worthy of clinical promotion and application.