重组甘精胰岛素等剂量转换为原研甘精胰岛素实现血糖更佳控制的3例2型糖尿病患者病例分析

Better Glucose Control After Switching from Recombinant Insulin Glargineto Insulin Glargine with Equal Insulin Dosage: Case Report on Three Type 2 Diabetes Patients

病例小结:3例使用重组甘精胰岛素联合餐时胰岛素治疗的2型糖尿病(type 2 diabetes mellitus,T2DM)患者,因血糖控制不佳入住内分泌科。入院后维持原治疗方案,平均空腹血糖(fasting blood glucose,FBG)分别为8.83mmol/L、9.52mmol/L、13.37mmol/L,血糖波动较明显。等剂量转换为原研甘精胰岛素后,平均FBG分别为5.54mmol/L、5.90mmol/L、7.96mmol/L,血糖平稳。原研甘精胰岛素剂量分别由20IU、20IU、20IU调整至12IU、16IU、18IU,餐时胰岛素剂量基本维持不变。以上患者治疗期间未观察到不良反应或低血糖发生。结论:在3例使用重组甘精胰岛素控制FBG不佳且血糖波动较大的T2DM患者,等剂量转化为原研甘精胰岛素后,FBG控制更佳且平稳,胰岛素剂量明显减少,以上临床疗效差异可能归因于加强患者饮食运动教育、规范胰岛素注射技术及两种长效基础胰岛素在蛋白结构、生产工艺、免疫原性、注射装置等方面所致,更确切结论仍需随机对照或真实世界研究验证。

Case summary:Three type2diabetes patients treated with recombinant insulin glargine and prandial insulin were administrated into theEndocrinologyin Department because of poor glucose control.Previous insulin treatment regimen was maintained for at least three days.The mean FBGvalue was8.83mmol/L,9.52mmol/L,13.37mmol/L,respectively.Meanwhile,glycemic fluctuation was high.The mean FBG value was5.54mmol/L,5.90mmol/L,7.96mmol/L with lower glycemic fluctuation afterswitching to insulin glargine.And Insulin dosage of Lantus was adjusted from20IU,20IU,20IU to12IU,16IU,18IU,respectively.The dosage of prandial insulin almost maintains the same level.Conclusion:Better FBG control,lower glycemic fluctuation and lower insulin dosage afterswitching from recombinant insulin glargineto insulin glargine with equal insulin dosagewere achieved.Enhancement on dietary and exercise education,standardization of insulin injection technology and difference of protein structure,manufacturing process,immunogenicity and injection devices between the two basal insulin may contribute to the clinical efficacy difference.Morerandomized controlled trials or real world study should be conducted before solid conclusion.