地特胰岛素治疗老年2型糖尿病疗效和安全性

Curative effect and safety of insulin detemir in treatment of senile type 2 diabetes mellitus

目的 探讨地特胰岛素治疗老年2型糖尿病患者的疗效和安全性。方法 选取2013年12月~2015年12月于东南大学附属中大医院江北院区收治的2型糖尿病患者90例，其中男性54例，女性36例，年龄65～74岁，平均（69.01±3.47）岁。根据用药种类不同分为A组、B组和C组，各30例。所有患者治疗前行糖尿病的健康宣教，于治疗期间控制饮食并进行适当体育活动，三餐前给予皮下注射赖脯胰岛素4U，此外于睡前分别给予A组地特胰岛素，B组甘精胰岛素，C中效胰岛素（诺和灵），均为8U，疗程为3个月，记录患者治疗期间血糖达标时间、胰岛素用量、低血糖情况。治疗3个月后进行动态血糖监测，24 h平均血糖值（MBG）、24 h血糖标准差（SDBG）、全天平均血糖波动幅度（MAGE）、日间血糖平均绝对差（MODD）和餐后血糖漂移幅度（PPGE）以及检测治疗前后空腹血糖（FBG）、餐后2 h血糖（2h PBG）、糖化血红蛋白（HbAlc）、体质指数（BMI）。自治疗起以电话或门诊的方式随访6个月，记录心血管事件发生情况。结果 治疗3个月后，A组和B组患者的BMI、FBG、2h PBG以及HbAlc均明显低于C组，差异有统计学意义（P均＜0.05）。但A、B两组BMI、FBG、2h PBG以及HbAlc指标比较，差异无统计学意义（P均＞0.05）。治疗期间，A组和B组血糖达标时间、胰岛素用量以及低血糖发生率比较，差异无统计学意义（P均＞0.05）。A组和B组胰岛素用量以及低血糖发生率均明显低于C组，血糖达标时间长于C组，差异具有统计学意义（P均＜0.05）。从血糖的波动情况来看，与C组比较，A组和B组患者MBG、SDBG、MAGE、MODD、PPGE均降低，差异有统计学意义（P均＜0.05）。A组和B组心血管事件发生率明显低于C组，（16.67% vs. 53.33%），（23.33% vs. 53.33%），差异有统计学意义（P均＜0.05）。结论 老年2型糖尿病患者应用地特胰岛素较中效胰岛素血糖控制效果更佳，安全性更高。

Objective To discuss the curative effect and safety of insulin detemir in treatment of senile type2 diabetes mellitus (T2DM). Methods T2DM patients (n=90, male 54, female 36, aged from 65 to 74 and averageage=69.01±3.47) were chosen from Dec. 2013 to Dec. 2015, and divided, according to different types of drugs, into groupA, group B and group C (each n=30). All patients were given health education on diabetes, and promoted to control dietand have some sport exercises. All patients were given hypodermic injection of insulin lispro (4 U) before 3 meals, andin addition, group A was given insulin detemir (8 U), group B, insulin glargine (8 U) and group C, intermediate-actinginsulin (Novolin, 8 U) for 3 m. The duration of blood sugar controlled to target levels, dosage of insulin and incidence ofhypoglycemia were recorded during treatment period. After treatment for 3 m, the patients were given dynamic blood sugarmonitoring for recording 24h mean blood glucose (24h MBG), 24h standard deviation of blood glucose (24h SDBG), meanamplitude of glycemic excursions (MAGE), mean of daily differences (MODD) and postprandial blood glucose excursion(PPGE). The changes of fasting blood glucose (FBG), 2h postprandial blood glucose (2h PBG), glycated hemoglobin(HbAlc) and body mass index (BMI) were detected. The patients were followed up through telephones or clinic for 6 m for recording the incidence of cardiovascular events. Results After treatment for 3 m, BMI, FBG, 2h PBG and HbAlc weresignificantly lower in group A and group B than those in group C (all P<0.05). The difference in BMI, FBG, 2h PBG andHbAlc had no statistical significance between group A and group B (all P>0.05). During treatment period, the differencein duration of blood sugar controlled to target levels, dosage of insulin and incidence of hypoglycemia had no statisticalsignificance between group A and group B (all P>0.05). The dosage of insulin and incidence of hypoglycemia weresignificantly lower, and duration of blood sugar controlled to target levels was longer in group A and group B than thosein group C (all P<0.05). MBG, SDBG, MAGE, MODD and PPGE all decreased in group A and group B compared withgroup C (all P<0.05). The incidence of cardiovascular events were significantly in group A and group B than that in groupC (16.67% vs. 53.33%; 23.33% vs. 53.33%, all P<0.05). Conclusion The controlling effect on blood sugar and safety ofinsulin detemir are higher than those of intermediate-acting insulin in elderly patients with T2DM.