中、低预混胰岛素类似物对2型糖尿病患者血糖波动的影响

Effects of middle or low premixed insulin analogue on glycemic variations in patients with type 2 diabetes mellitus

目的:比较精蛋白锌重组赖脯胰岛素混和注射液50R(优泌乐50)和门冬胰岛素30注射液(诺和锐30)对2型糖尿病(T2DM)患者血糖波动的影响。方法:入组T2DM患者持续皮下输注胰岛素强化,血糖达标2 d后行优泌乐50或诺和锐30每日3次治疗,血糖再次达标后进入4 d交叉研究,全程96 h动态血糖监测(CGM)覆盖。结果:优泌乐50和诺和锐30对患者24 h平均血糖、平均血糖波动幅度(MAGE)、高血糖(>10.0 mmol·L^(-1))和低血糖(<3.9 mmol·L^(-1))曲线下面积(AUC)等差异均无统计学意义;但相同剂量的优泌乐50较诺和锐30能更好地改善男性患者的MAGE[(4.52±2.50)vs(5.53±1.90)mmol·L^(-1),P<0.05];两组患者均无低血糖事件发生。结论:中、低预混胰岛素类似物对T2DM患者总人群血糖波动的影响相似,但中预混胰岛素能更好地控制男性T2DM患者血糖波动。

Objective： To compare the effect of mixed protamine zinc recombinant human insulin lispro injection 50R（Humalog Mix 50） with that of insulin aspart 30 injection（Novo Mix 30）on glycemic variations in patients with type 2 diabetes mellitus（T2DM）.Methods： The recruited patients were treated with continuous subcutaneous insulin infusion for achieving euglycemic control.The patients were then treated with Humalog Mix 50 or Novo Mix 30 thrice-daily for another 2 days followed by 4-day cross-over treatment.Continuous glucose monitoring（CGM） was performed in all the subjects for at least 96 hours during the cross-over study period.The 24 hour mean glucose（24 hr MG）, the mean amplitude of glycemic excursions（MAGE） and the incremental area under curve（AUC） of glucose concentrations above 10 mmol·L-1 or less than 3.9 mmol·L-1 were analyzed.Results： There were no significant differences in the 24 hr MG, the MAGE and the incremental AUC〉10.0 mmol·L-1 or ＆lt;3.9 mmol·L-1 between the groups.However, the MAGE was significantly improved in male patients with T2DM treated with Humalog Mix 50 compared with those treated with Novo Mix 30.Conclusion： T2DM patients treated with middle or low premixed insulin analogue have similar improvement of glycemic variations.Moreover, male patients treated with middle premixed insulin analogue get better improvement in glycemic variations compared with those treated with low premixed insulin analogue therapy.