三种胰岛素皮下注射方案对血糖治疗达标的2型糖尿病患者血糖变异性及低血糖发生率的影响

Effects of three subcutaneous insulin injection regimens on blood glucose variability and the incidence of hypoglycemia in type 2 diabetes mellitus patients with blood glucose up to standard after treatment

目的:探讨3种胰岛素皮下注射方案对血糖治疗达标的2型糖尿病患者血糖变异性及低血糖发生率的影响。方法:选取2017年3月至2019年6月于东部战区总医院就诊的81例经胰岛素泵治疗后血糖达标的2型糖尿病患者为研究对象,随机分为门冬胰岛素30联合地特胰岛素组(A组)、门冬胰岛素30组(B组)、精蛋白生物合成人胰岛素组(C组),每组各27例患者。对比3组患者体质量指数(BMI)、空腹血糖(FBG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)、血糖的变异性及低血糖的发生率。结果:3组患者治疗3个月后的BMI、2hPG及糖化血红蛋白(HbA1c)水平较治疗前无显著差异(P>0.05),但治疗后的FBG水平均显著高于治疗前(P<0.05),且3个月后C组FBG水平显著高于A组和B组(P<0.05),但A组FBG水平与B组比较无显著差异(P>0.05)。3组患者治疗后的24 h平均血糖(24hMBG)水平无显著差异(P>0.05),B组和C组最大血糖幅度(LAGE)、1 d内平均血糖波动幅度(MAGE)、血糖变异系数(CV)及空腹血糖变异系数(CV-FBG)水平均显著高于A组(P<0.05),A组LAGE、MAGE、CV及CV-FBG水平显著低于B组(P<0.05)。B组与C组血糖达标时间、胰岛素剂量及低血糖的发生率显著高于A组(P<0.05)。结论:门冬胰岛素30联合地特胰岛素方案对血糖治疗达标的2型糖尿病患者临床疗效显著,可有效地降低其血糖变异性及低血糖的发生率。

Objective:To investigate the effects of three subcutaneous insulin injection regimens on blood glucose variability and the incidence of hypoglycemia in type 2 diabetes mellitus patients with blood glucose up to standard after treatment.Methods:Totally,81 type 2 diabetes mellitus patients with blood glucose up to standard after treatment who sought medical care in the General Hospital of Eastern Theater Command from March 2017 to June 2019 were selected as the subjects,and were randomly divided into three groups:the insulin aspart 30 and insulin detemir group(or group A),the insulin aspart 30 group(or group B)and the protamine biosynthetic human insulin group(or group C),with 27 patients in each group.The body mass index(BMI),fasting blood glucose(FBG),2 h postprandial blood glucose(2hPG),glycosylated hemoglobin(HbA1c),blood glucose variability and the incidence of hypoglycemia were compared between the three groups.Results:There were no significant differences in the levels of BMI,2hPG and HbA1c in the patients of the three groups after 3-month treatment when compared with those before treatment(P>0.05),but the FBG level after treatment in the patients of the three groups was significantly higher than that before treatment(P<0.05),and the FBG level in group C after 3-month treatment was significantly higher than that in group A and group B(P<0.05).However,there were no significant differences when comparisons were made between group A and group B(P>0.05).There were no significant differences in mean blood glucose level in 24 hours(24hMBG)after treatment for the patients of the three groups.The mean amplitude of glucose excursion(MAGE),the largest amplitude of glucose excursion(LAGE),the coefficient of variation of blood glucose(CV)and the coefficient of variation of fasting blood glucose(CV-FBG)in group B and C were higher than those in group A(P<0.05),and the levels of LAGE,MAGE,CV and CV-FBG in group A were lower than those in group B(P<0.05).The time of reaching blood glucose standard,insulin dosage and incidence of hypoglycemia in group B and C were significantly higher than those of the patients in group A(P<0.05).Conclusion:The combination of insulin aspart 30 and insulin detemir in the treatment of type 2 diabetes mellitus patients with blood glucose up to standard after treatment could achieve significant therapeutic effects and effectively reduce the blood glucose variability and the incidence of hypoglycemia.