应用动态血糖监测评价甘精胰岛素治疗2型糖尿病患者血糖控制的研究

Using continuous glucose monitoring to evaluate the glycemic control in type 2 diabetes mellitus patients treated with insulin glargine

目的观察应用动态血糖监测(CGM)评价甘精胰岛素治疗的门诊T2DM患者治疗方案调整前后血糖控制情况。方法选取2017年2月至2018年8月于我院内分泌科门诊治疗的T2DM患者105例,随访3个月。随访前后均进行72 h CGM监测,测定血糖、HbA1c、胰岛功能等指标。结果 105例患者基线HbA1c(8.11±1.52)%,HbA1c<7%达标率为24.3%。79例患者完成本研究。治疗方案调整后胰岛素及二甲双胍使用率增加[(21.59±8.36)vs(18.77±5.63)U/d,74.68%vs 53.16%,P<0.05];FBG、HbA1c及C-P120 min/0 min较调整前改善[(8.63±2.62)vs(7.06±1.91)mmol/L,(8.29±1.52)%vs(7.26±1.00)%,(2.52±1.30)vs(3.60±1.67),P<0.05];24 h平均血糖(24 hMBG)、日内血糖平均波动幅度(MAGE)较调整前下降[(10.15±2.59)vs(8.65±1.71)mmol/L,(5.75±2.73)vs(5.04±2.9)mmol/L,P<0.05]。结论甘精胰岛素联合口服药物降糖治疗的T2DM门诊患者整体血糖控制效果欠佳。增加胰岛素剂量及二甲双胍使用率后,患者血糖、餐后胰岛功能反应性、胰岛细胞敏感性及血糖波动均得到改善。

Objective To evaluate the glycemic control of type 2 diabetes mellitus(T2DM)patients treated with insulin glargine before and after the adjustment of treatment by continuous glucose monitoring(CGM).Methods A total of 105 T2DM patients in Endocrinology Clinic of our hospital were recruited and followed up for 3 months.72-hour continuous glucose monitoring(CGM)was applied to all patients,and the blood glucose,HbA1c and islet function were measured at baseline and after follow up for 3 months.Results The average HbA1c was(8.11±1.52)%,with 24.3% reached the target(HbA1c < 7%).A total of 79 patients completed this study.After therapy adjustment,the dosage of insulin and the rate of metformin therapy were increased[(21.59±8.36)vs(18.77±5.63)U/d,74.68% vs 53.16%,P<0.05].FBG,HbA1c and the C-peptide120 min/0 min were improved[(7.06±1.91)vs(8.63±2.62)mmol/L,(7.26±1.00)vs(8.29±1.52)%,(3.60±1.67)vs(2.52±1.30),P<0.05].The 24 hMBG and MAGE were also improved[(8.65±1.71)vs(10.15±2.59)mmol/L,(5.04±2.9)vs(5.75±2.73)mmol/L,P<0.05].Conclusion The glycemic control of T2DM patients treated with insulin glargine and oral hypoglycemic drugs was unsatisfactory in clinic.After increasing the insulin dosage and the usage of metformin,the blood glucose,postprandial islet function responsiveness,islet function and the blood glucose fluctuation were improved.