适合老年2型糖尿病患者的每日2次德谷门冬双胰岛素剂量分配方案探讨

Study on the dosage distribution scheme of IDegAsp twice a day for elderly patients with type 2 diabetes

目的 德谷门冬双胰岛素在老年2型糖尿病患者中的应用经验有限。本研究探讨适合老年糖尿病患者的每日2次双胰岛素剂量分配方案。方法 选取华东医院2020年3月—2023年6月期间内分泌科就诊的老年2型糖尿病患者共278例,均接受稳定剂量的每日2次双胰岛素或预混胰岛素且HbA1c<7%,经连续血糖监测证实葡萄糖目标范围内时间(TIR)>70%,葡萄糖低于目标范围时间(TBR)<1%。比较每组每日总胰岛素、早餐前胰岛素、晚餐前胰岛素及早晚餐前胰岛素比值。结果 双胰岛素组的总胰岛素、早餐前胰岛素和晚餐前胰岛素的平均剂量分别为(27.8±8.0) U/d、(17.0±4.8) U/d和(10.8±4.1) U/d。早晚餐前胰岛素比值的中位数为1.6,高于其他预混胰岛素的1.4 (P=0.022)。空腹C肽与早晚餐前胰岛素比值呈负相关(r=-0.301,P=0.016),与晚餐前胰岛素呈正相关(r=0.247,P=0.049)。结论 老年糖尿病患者使用双胰岛素的初始剂量可以在早晚餐前以1.6∶1的比例分配,而不是通常推荐的1∶1。如果由其他种类预混胰岛素转换,建议适当减少晚餐前剂量,且胰岛功能越差晚餐前剂量越小。

Objective The application experience of IDegAsp in elderly patients with type 2 diabetes was limited.This study was to explore a twice daily IDegAsp doseage distribution scheme for elderly patients with diabetes.Methods 278 elderly patients with type 2 diabetes were selected from Department of Endocrinology of Huadong Hospital from March 2020 to June 2023.All of them received a stable dose of IDegAsp or premixed insulin twice a day,and with HbA1c<7%.Continuous blood glucose monitoring confirmed that the time within the target range(TIR)of glucose was>70%,and the time below the target range(TBR)of glucose was<1%.The daily total insulin dosage,pre-breakfast insulin dosage,pre-dinner insulin dosage,and ratio of pre-breakfast/pre-dinner insulin dosage were compared among the groups.Results The average dosage of the total insulin,pre-breakfast insulin and pre-dinner insulin of the IDegAsp group were(27.8±8.0)U/d,(17.0±4.8)U/d,and(10.8±4.1)U/d,respectively.Its median ratio of pre-breakfast/pre-dinner insulin dosage was 1.6,which was higher than that of the other premixed insulin groups(1.4)(P=0.022).The level of fasting C-peptide was negatively correlated with the ratio of pre-breakfast/pre-dinner insulin dosage(r=-0.301,P=0.016),and positively correlated with pre-dinner insulin dosage(r=0.247,P=0.049).Conclusion The initial dose of IDegAsp for elderly patients with diabetes can be distributed at a ratio of 1.6∶1 before breakfast and dinner,rather than the generally recommended 1∶1.If it is converted from other types of premixed insulin,it is recommended to appropriately reduce the pre-dinner dosage,and the poorer the pancreatic function,the smaller pre-dinner dosage.