口服降糖药物失效糖尿病患者胰岛素治疗方案选择分析

Selection of initial insulin therapeutical scheme in diabetic patients with oral glucose control failure

目的比较分析两种不同胰岛素治疗方案对口服降糖药物失效糖尿病患者的控糖效果。方法采用随机数字表法将100例口服降糖药物失效糖尿病患者分为观察组与对照组,观察组采用门冬胰岛素30治疗,对照组则采用原有降糖药物+甘精胰岛素治疗,比较两组治疗前后血糖指标、体质量指数(BMI)及胰岛β细胞功能(HOMA-β)变化,记录两组糖化血红蛋白(HbA1c)达标率、低血糖发生率及胰岛素用量。结果与治疗前比较,两组治疗后空腹血糖、餐后2h血糖、HbA1c均明显下降,BMI、HOMA-β均明显上升,治疗前后比较差异有统计学意义(P<0.05),但两组治疗后组间比较差异无统计学意义(P>0.05)。观察组治疗前HbA1c>10%~13%,治疗后HbA1c<7.0%达标率62.96%,明显高于对照组的35.71%,差异有统计学意义(P<0.05);观察组低血糖发生率、平均胰岛素用量均明显高于对照组,差异有统计学意义(P<0.05)。结论加用甘精胰岛素、门冬胰岛素30皮下注射均能良好控制口服降糖药物失效糖尿病患者血糖水平及改善其HOMA-β,前者相比后者胰岛素用量明显减少,低血糖发生率明显降低,但后者HbA1c>10%的患者治疗有明显优势。

Objective To compare and analyze the glucose control effect between two different initial insulin treatment schemes in diabetic patients with oral hypoglycemic agents glucose control failure.Methods A total of 100 diabetic patients with oral hypoglycemic agents glucose control failure were divided into the observation group and control group by the random number table method.The observation group adopted insulin aspart 30,while the control group was treated with original hypoglycemic drugs combined with insulin glargine.The blood glucose indexes,body mass index and pancreaticβ-cell function were compared between the two groups before and after treatment.The HbAlc standard reaching rate,incidence rate of hypoglycemia and insulin dosage were recorded in the two groups.Results Compared with those before treatment,the levels of FPG,2hHPG and HbA1 cin the two groups after treatment were significantly decreased,while BMI and HOMA-βwere significantly increased,the differences between before and after treatment were statistically significant（P〈0.05）,but there was no statistically significant difference between the two groups after treatment（P〉0.05）.The HbA1 clevel before treatment in the observation group was 〉10%-13%,which after treatment was〈7.0%,the standard reaching rate was 62.69%,which was significantly higher than 35.71%in the control group,the difference was statistically significant（P〈0.05）;the incidence rate of hypoglycemia and average insulin dosage in the observation group were significantly higher than those in the control group,the difference was statistically significant（P〈0.05）.Conclusion Adding insulin glargine and instead of subcutaneous injection of insulin aspart 30 can better control the blood glucose level and improves HOMA-βin diabetic patients with oral hypoglycemic agents glucose control failure.Compared with the latter,the insulin dosage of the former is significantly decreased and the incidence rate of hypoglycemia is significantly decreased,but the latter has obvious advantages in the treatment of the patients with HbA1c〉10%.