谷赖胰岛素餐后注射和餐前注射的疗效对比

Comparison of efficacy between postprandial and preprandial injection of glulisine

目的 比较谷赖胰岛素餐前注射与餐后注射的效果。方法 选取使用甘精胰岛素＋谷赖胰岛素强化降糖且胰岛素剂量稳定1周以上的T2DM患者60例，随机（SPSS软件生成平均分布的随机数）分为A组和B组。采用2阶段交叉设计，第一阶段：A组（30例）谷赖胰岛素餐前注射，B组（30例）谷赖胰岛素餐后注射，观察3d：进入第二阶段：A组谷赖胰岛素改为餐后注射，B组谷赖胰岛素改为餐前注射，继续观察3d。统计2组每阶段第3天的24h血糖水平的标准差（standa deviationof blood glueose，SDBG）、餐后血糖波动幅度（postprandial glucose excursions，PPGE）、最大血糖波动幅度（1argest amplitude of glycemic excursions，LAGE）及胰岛索治疗满意度评分（satisfaction values of insulin treatment，SVIT）。结果2组患者入组前年龄（（50．70±13．29）岁vs（55．63±13．05）岁，P=0．152）、糖尿病病程（（36．23±29.20）个月vs（43.63±32．19）个月，P=（1355）、糖化血红蛋白水平（（10．05％±1A6％vs9．81％±2．08％，P=0．612）、胰岛素日剂量（（35．67±8．64）Uvs（34．83±8．24）U，P=0．704）、SDBG（（2．63±0．58）vs（2．84±0．64）），差异均无统计学意义。2阶段试验结束后，采用SPSS软件General Linear Model方差分析显示，谷赖胰岛素餐前注射与餐后注射比较，SDBG（F=0．432，P=0．73）、PPGE（F=I．216．P=0．31）、LAGE（F=0．431，P=10．73）及SVrr（F=0．685。P=0．56）差异均无统计学意义。结论谷赖胰岛索餐后注射与餐前注射比较，在降糖效果、治疗满意度及血糖波动方面均无差异。

Objective To compare the therapeutic eft±ct of postprandial and preprandial injection of glulisine. Methods Sixty hospitalized patients with T2DM receiving one dose of glargine and three doses of glulisine were recruited. They were randomly divided into two groups： group A and group B when the glycemic state and insulin dosages had been stable for more than seven days. Two-stage cross design： stage 1： group A （n= 30）： glulisine was injected before meal; Group B （n=30）： glulisine was injected after meal. Blood glucose was monitored for three days. Stage 2： glulisine was injected after meal in group A while before meal in group B with- out dosages adjustment, and blood glucose was monitored continuously for three days. Then standard deviation of blood sugar （SDBG）, blood glucose fluctuation after meal （PPGE）, maximum blood glucose fluctuation range （LAGE） during 24 hour and satisfaction values of insulin treatment （SVIT） were compared. Results There was no significant differences between group A and group B in terms of age（（50.70±13.29 ）years vs （55.63±13.05） years, P=0,152）, diabetes course（ （36.23±29.20）months vs （43.63±32.19） months, P=0.355）, HbAIe（ （10.05%± 1.46%）vs （9.81%±2.08%, P=0.612）, daily insulin dose（（35.67±8.64）U vs （34.83±8.24） U, P=0.704）, SDBG （（2.63±0.58 vs （2.84±0.64）） before operation. There was no significant differences of SDBG （F=0.432 ,P=0.73）, PPGE （F=1.216,P=0.31）, LAGE（F=0.431 ,P=0.73） or SVIT（F=O.685,P=0.56） between glulisine injected be fore and after meal. Conclusion Postprandial glulisine administration can provide the same effect in lowering glucose, satisfaction values and reducing glucose fluctuation as preprandial injection.