胰岛素泵持续皮下注射联合二甲双胍治疗妊娠期糖尿病的临床效果及对其糖脂代谢与母婴结局的影响

Clinical effect of continuous subcutaneous injection of insulin pump combined with metformin on gestational diabetes mellitus and its effects on glucose and lipid metabolism and maternal and neonatal outcomes

目的观察胰岛素泵持续皮下注射联合二甲双胍治疗妊娠期糖尿病(GDM)患者的临床效果及对其糖脂代谢与母婴结局的影响。方法选取2020年2-11月衡阳市中心医院收治的GDM确诊患者138例,采用随机数表法分为观察组与对照组,各69例。在常规饮食与运动指导基础上,对照组予德谷门冬双胰岛素注射液治疗,观察组则在对照组基础上联合盐酸二甲双胍缓释片治疗。比较2组患者治疗效果,治疗前与治疗12周后糖脂代谢指标[空腹血糖(FBG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(Hb A1c)、总胆固醇(TC)、三酰甘油(TG)和低密度脂蛋白胆固醇(LDL-C)]及不良母婴结局。结果治疗12周后,观察组总有效率为98.55%,高于对照组的86.96%(χ^(2)=6.900,P=0.009);2组FBG、2 h PG、Hb A1c、TC、TG和LDL-C水平均较治疗前下降,且观察组低于对照组(P均<0.01);观察组不良母婴结局总发生率为8.70%,明显低于对照组的28.99%(χ^(2)=9.288,P=0.002)。结论胰岛素泵持续皮下注射联合二甲双胍治疗妊娠期糖尿病的临床效果确切,对患者糖脂代谢与母婴结局均有积极影响,值得临床推广应用。

Objective To observe the clinical effect of continuous subcutaneous injection of insulin pump combined with metformin on gestational diabetes mellitus( GDM) and its effects on glucose and lipid metabolism and maternal and neonatal outcomes. Methods One hundred and thirty-eight patients with GDM diagnosed in Hengyang Central Hospital from February to November 2020 were selected. The patients were randomly divided into observation group and control group,with69 cases in each group. On the basis of routine diet and exercise guidance,the control group was treated with insulin degludec and insulin aspart injection,while the observation group was treated with metformin hydrochloride sustained-release tablets on the basis of the control group. The treatment effects,glucose and lipid metabolism indexes( FBG,2 h PG,Hb A1 c,TC,TG,LDL-C) and adverse maternal and infant outcomes were compared between the two groups before and 12 weeks after treatment.Results After 12 weeks of treatment,the total effective rate in the observation group was 98. 55%,higher than 86. 96% in the control group( χ;= 6. 900,P = 0. 009). The levels of FBG,2 hPG,HbA1 c,TC,TG and LDL-C in the observation group were lower than those in the control group( all P < 0. 01). The total incidence of adverse maternal and infant outcomes in the observation group was 8. 70%,significantly lower than 28. 99% in the control group( χ;= 9. 288,P = 0. 002).Conclusion Continuous subcutaneous injection of insulin pump combined with metformin is effective in the treatment of gestational diabetes mellitus. It has a positive effect on glucose and lipid metabolism and maternal and neonatal outcomes,and is worthy of clinical application.