2型糖尿病胰岛素泵强化治疗后胰岛素剂量谱的分析及应用

Application of insulin dose spectrum after an intensive insulin pump therapy in type 2 diabetes mellitus

目的探讨2型糖尿病(type 2 diabetesmellius,T2DM)患者预混胰岛素类似物的治疗时间、治疗时机和种类。方法收集中国宁波市5家医院应用CSII短期强化治疗的2型糖尿病患者655例,分析确定最佳预混胰岛素类似物治疗方案。结果CSII滴定后胰岛素用量,餐前胰岛素总量/基础胰岛素总量比值为1.12;胰岛素总量(51.35±29.7)U。晚餐前有58%推荐中预混胰岛素类似物为宜。早餐前74%推荐低预混胰岛素类似物为宜。根据患者个体化巧妙搭配不同剂型预混胰岛素类似物来达到最佳的控制血糖的效果。预混一天两次注射(BID)早晚推断剂量均值比为3∶2。早多晚少的预混胰岛素类似物剂量比值有助于更简易地告知患者胰岛素的剂量,避免早晚剂量的混淆导致低血糖的发生。胰岛素泵强化治疗的结果显示:糖尿病患者的胰岛素剂量谱具有极大的异质性,量化的选择更有意义。结论一天两次注射(BID)预混胰岛素类似物方案:晚餐前推荐中预混为宜,早餐前推荐低预混为宜。临床上大部分患者选用单种胰岛素治疗,医生可根据患者血糖、个体差异,或联合口服降糖药,在两款剂型中选择最佳方案。

Objective To explore the treatment time,timing and type of premixed insulin analogs in patients with type 2 diabetes mellitus(T2DM).Methods A total of 655 T2DM patients treated with continuous subcutaneous insulin infusion(CSII)short-term intensive treatment in 5 hospitals in Ningbo City,China were recruited to determine the optimal treatment plan of premixed insulin analogs.Results After CSII titration,the ratio of insulin dosage before meals to total basal insulin was 1.12,with the total insulin dosage of 51.35±29.7 U.58%of T2DM patients were recommended to the use of premixed insulin analogs before dinner.74%of them were recommended to the use of low premixed insulin analogs before breakfast.An individualized preparation of premixed insulin analogs with varied dosage formulations was expected to yield the optimal goal to control blood sugar.An inferred ratio of premixed insulin analogs twice a day(b.i.d.)in the morning and evening was 3∶2.A higher dosage in the morning than evening favored a simple informed consent of insulin dosage,thus preventing the misuse of premixed insulin analog dosages in the morning and evening and the incidence of hypoglycemia.An intensive insulin pump therapy showed that the insulin dose spectrum of T2DM was extremely heterogeneous,and a quantitative selection was of more significance.Conclusion A premixed insulin analog regimen b.i.d.is recommended,with a medium premixing before dinner,and low premixing before breakfast.A single type of insulin is dominant in clinical treatment of T2DM.An optimal regimen of the two types of premixed insulin analogs,either combined with oral hypoglycemic drugs or not,can be selected based on the individualized conditions of blood sugar.