一组强化治疗妊娠期高血糖患者的胰岛素应用状况和特点

The situation and feature of the intensive insulin therapy in a group of hyperglycemic patients during pregnancy

回顾糖尿病合并妊娠（PGDM）、妊娠期显性糖尿病（DIP）、妊娠期糖尿病（GDM）和育龄期普通女性2型糖尿病共141例患者在住院期间的胰岛素强化治疗情况，分析血糖控制达标率、胰岛素用量及低血糖发生率。结果显示，4组问的总体达标率相当（P=0．906）；与GDM组比较，PGDM组、DIP组、2型糖尿病组单位体重日最高胰岛素用量均明显增高[0．65（0．47—1．00）、0．67（0．38—1．05）、0．65（0．52-0．82）对0．45（0．29-0．61）U·kg^-1·d^-1，P〈0．05或P〈0．01]，后三者问则差异无统计学意义；在所有患者中，4组低血糖事件次数和发生率无显著差异（P=0．339）。在血糖达标患者中，4组低血糖事件次数和发生率存在差异（P=0．002），与2型糖尿病组相比，PGDM组、DIP组、GDM组低血糖发生率均降低（P〈0．05或P〈0．01）。

Relevant clinical data of 141 cases diagnosed pregestational diabetes mellitus （ PGDM ）, diabetes mellitus in pregnancy （ DIP ）, gestational diabetes mellitus （ GDM ）, and type 2 diabetes mellitus （ T2DM ） were collected. The blood glucose control rate, insulin dose, and episode of hypoglycemia in the insulin intensive therapy were retrospectively analyzed. The results showed that there was no significant difference in the control rate among the four groups （ P = 0. 906 ）. The insulin dose/weight in GDM was significantly lower than those in PGDM, DIP, and T2DM groups [0.65（0.47-1.00）, 0.67（0.38-1.05）, 0.65（0.52-0.82）vs0.45（0.29-0.61）U · kg ^-1 · d^-1, p〈 0.05 or P〈0.01 ]. There was no significant difference in episode or incidence rate of hypoglycemia among the overall four groups （ P = 0. 339 ）. However in the patients with blood glucose reaching the control standard, the rate of hypoglycemia in T2DM was significantly higher than those in PGDM, DIP, and GDM （ P〈0.05 or P〈0.01 ）.