谷赖胰岛素与门冬胰岛素治疗胰岛β细胞功能衰竭2型糖尿病的疗效与安全性比较

Comparison of efficacy and safety of insulin glulisine and insulin aspart in treatment of islet beta cell dysfunction in type 2 diabetes patients

目的探讨谷赖胰岛素与门冬胰岛素联合甘精胰岛素在治疗胰岛β细胞功能衰竭2型糖尿病的疗效与安全性差异。方法选取2015年12月-2016年6月于吉林大学第二医院内分泌科住院及门诊治疗的胰岛β细胞功能衰竭的2型糖尿病患者68例。所有入选患者进行糖尿病宣传教育、饮食及运动控制,监测每日空腹、餐前、三餐后2 h及睡前血糖。入选患者随机分为两组,实验组给予谷赖胰岛素联合甘精胰岛素皮下注射降糖治疗,对照组给予门冬胰岛素联合甘精胰岛素皮下注射降糖治疗,比较两组在治疗前后空腹、餐前、三餐后2 h睡前血糖变化、日需胰岛素剂量、糖化血红蛋白(Hb A1c)变化及低血糖发生次数。结果 (1)经过3个月的治疗随访观察,两组在空腹、餐前、三餐后2 h、睡前血糖及糖化血红蛋白上均较治疗前有下降(P<0.05);(2)两组在控制血糖达标所需日胰岛素剂量比较差异无统计学(P>0.05);(3)对照组在餐前及夜间血糖控制上优于实验组(P<0.05);(4)实验组在控制餐后2 h血糖上优于对照组(P<0.05);(5)两组在糖化血红蛋白控制上差异无统计学(P>0.05);(6)实验组的低血糖次数少于对照组,差异有统计学意义(P<0.05)。结论谷赖胰岛素联合甘精胰岛素较门冬胰岛素联合甘精胰岛素能更好控制胰岛β细胞功能衰竭2型糖尿病的血糖,耐受好、低血糖发生次数少及降低血糖波动,减少或延缓糖尿病的各种急慢性并发症发生。

Objective To discuss the differences in curative effect and safety between insulin glulisine with insulin glargine and insulin aspart with insulin glargine when treating islet beta cell dysfunction in type2 diabetes. Methods Sixty-eight type 2 diabetes patients with islet beta cell dysfunction who were hospitalized in the Endocrinology Department of the Second Hospital of Jilin University or received outpatient treatment from December 2015 to June 2016 were selected and randomly divided into the experimental group administered with a glucose-lowering treatment through subcutaneous injection of insulin glulisine with insulin glargine and the control group administered with a glucose-lowering treatment through subcutaneous injection of insulin aspart with insulin glargine. All the cases received publicity and education of diabetes, and diet and exercise management. The changes of blood glucose of fasting, before meal, 2 hours after three meals and bedtime, daily insulin dose, glycosylated hemoglobin（Hb A1c） and frequency of hypoglycemia were compared before and after treatment. Results Through three months of follow-up, there was a significant decline in both groups in terms of glucose of fasting, before meal, 2 hours after three meals and bedtime, and Hb A1 c compared with the counterparts before treatment（P〈0.01）. There was no significant difference in daily insulin dose to target level to control the glucose between the groups（P〈0.05）. The control group was better than the experimental group in terms of glucose control before meal and during nighttime（P〈0.05）. The experimental group was better than the control group in terms of controlling the glucose 2 hours after meal（P〈0.05）.There was no significant difference in controlling the glycosylated hemoglobin between the groups（P〈0.05）.The experimental group evidently had a lower frequency of hypoglycemia than the control group did, which was statistically significant（P〈0.05）. Conclusions Insulin glulisine combined with insulin glargine is better in controlling the glucose of patients with islet beta cell dysfunction in type 2 diabetes than insulin aspart combined with insulin glargine, performing a better tolerance and a lower frequency of hypoglycemia, lowering the glucose fluctuation and reducing or delaying the occurrence of various acute and chronic complications of diabetes.