Research Progress on the Efficacy and Safety of Different Basal Insulins in the Treatment of Type 2 Diabetes Mellitus

Objective:To evaluate the efficacy and safety of different basal insulins in the treatment of type 2 diabetes mellitus(T2DM).Methods:The current research progress on different basal insulins was evaluated,with efficacy indicators including fasting plasma glucose(FPG)and glycated hemoglobin(HbAic),and safety indicators focusing mainly on weight change and the incidence of hypoglycemia.Results:Several different basal insulins showed similar metabolic control effects in terms of fasting plasma glucose and glycated hemoglobin.However,the risk of hypoglycemia was lower with insulin glargine 300(Glar-300),insulin degludec 100(Deg-100),and insulin degludec 200(Deg-200)compared to insulin glargine 100(Glar-100).Additionally,Glar-300 had the least impact on weight.Conclusion:For the treatment of T2DM,different basal insulins have similar therapeutic effects,but there are differences in the incidence of hypoglycemic events and their impact on weight.Rational insulin selection and dosage adjustments should be made based on the different patient groups.

Neutral protamine hagedorn/regular insulin in the treatment of inpatient hyperglycemia: Comparison of 3 basal-bolus regimens

AIM To compare the safety and efficacy or 3 basal-bolus regimens of neutral protamine hagedorn(NPH)/regular insulin in the management of inpatient hyperglycemia.METHODS We randomized 105 patients with blood glucose levelsbetween 140 and 400 mg/dL to a basal-bolus regimen of NPH insulin given once(n = 30), twice(n = 40) or three times(n = 35) daily, in addition to pre-meal regular insulin. Major outcomes included were differences in glycemic control, frequency of hypoglycemia and total insulin dose.RESULTS NPH insulin given in a once-daily regimen was associated with better glycemic control(58.3%) compared to twice daily(42.4%) and three times daily(48.9) regimens(P = 0.031). The frequency of hypoglycemia was similar between the three groups(2.0%, 0.7% and 1.2%, P = 0.21). The mean insulin dose at discharge was 0.48 ± 0.14 U/kg in the once-daily group compared to 0.69 ± 0.28 in the twice-daily, and 0.65 ± 0.20 in the three times daily regimens(P < 0.001).CONCLUSION NPH insulin administered in a once-daily regimen resulted in improvement in glycemic control with similar rates of hypoglycemia compared to a twice-daily and a three times-daily regimen. Further studies are needed to evaluate whether this regimen could be implemented in all hospitalized patients with hyperglycemia.

中国基层医疗机构基础胰岛素的使用现状和选择的新思路

近年来,国家越来越重视基层医疗机构的服务质量,但是目前糖尿病的基层医疗现状并不令人十分满意。这与我国基层医疗机构的医护人员对基础胰岛素的认识不足有一定关系。本文从基础胰岛素在中国基层医疗机构的应用现状、使用障碍原因分析入手,重点比较基础胰岛素类似物(包括德谷胰岛素与甘精胰岛素)的有效性和安全性。结合近几年胰岛素集中采购的介绍,希望本文为中国基层医疗机构的基础胰岛素选择提供新的思路,从而更好地改善中国基层医疗机构的血糖控制。

德谷门冬双胰岛素与基础-餐时胰岛素短期强化治疗对新诊断2型糖尿病血糖控制的影响

目的 分析德谷门冬双胰岛素、基础-餐时胰岛素短期强化治疗对新诊断2型糖尿病(T2DM)患者血糖控制的影响。方法 选取60例新诊断T2DM患者为研究对象,依据随机数字法分为对照组(30例,德谷门冬双胰岛素治疗)、研究组(30例,基础-餐时胰岛素短期强化治疗)。对比两组患者的血糖指标[糖化血红蛋白(HbA1c)、空腹血糖(FPG)和餐后2 h血糖(2 h PBG)],血糖控制情况(血糖达标时间、血糖波动水平)和低血糖发生率,治疗效果。结果 两组治疗前HbA1c、FPG和2 h PBG水平对比无显著差异(P>0.05);治疗后,研究组HbA1c(6.08±0.76)%、FPG(5.71±0.59)mmol/L和2 h PBG(7.53±0.96)mmol/L比对照组的(8.19±1.14)%、(6.86±0.84)mmol/L、(9.38±1.33)mmol/L低,差异具有统计学意义(P<0.05)。研究组患者血糖达标时间为(6.95±1.61)d、血糖波动为(2.25±0.35)mmol/L、夜间低血糖发生率为0;对照组患者血糖达标时间为(8.26±1.56)d、血糖波动为(3.12±0.68)mmol/L、夜间低血糖发生率为20.00%;研究组患者的血糖达标时间、血糖波动水平和低血糖发生率均显著低于对照组,差异具有统计学意义(P<0.05)。研究组患者的治疗总有效率(100.00%)显著高于对照组(80.00%),差异具有统计学意义(P<0.05)。结论 对于新诊断T2DM患者来说,基础-餐时胰岛素短期强化治疗相对于德谷门冬双胰岛素疗效较好,值得推广。

Starting glargine in insulin-nave type 2 diabetic patients based on body mass index is safe

AIM:To evaluate the safety of four insulin titration algorithms in a homogeneous population of insulin-na ve type 2 diabetic patients.METHODS:We conducted a 24-wk,open,single-center study with 92 insulin-na ve type 2 diabetes patients who failed treatment with one or two oral drugs.The patients were randomized to one of the four following algorithms:LANMET(n=26)and LANMET PLUS(n=22)algorithms,whose patients received a fixed initial insulin dose of 10 U,and DeGold(n=23)and DeGold PLUS(n=21)algorithms,whose patients’initial insulin dose was based on their body mass index(BMI).In addition,patients in the PLUS groups had their insulin titrated twice a week from 2 to 8 U.In the other two groups,the titration was also performed also twice a week,but in a fixed increments of 2 U.The target fasting glucose levels for both groups was 100 mg/dL.RESULTS:There was no significant difference in efficacy parameters.There was no significant difference when comparing moderate hypoglycemia events in algorithms starting with a 10 U fixed dose and algorithms based on BMI.However,there was a significant increase in moderate hypoglycemia events among the PLUS treated patients when the LANMET and DeGold algorithms were compared with the 2 fast-titration PLUS algorithms.We observed 12 hypoglycemia events in the first group,which corresponded to 0.94 events/patient per year,and we observed 42 events in the second group,which corresponded to 2.81 events/patient per year(P<0.037).No further significant differences were observed when other comparisons between the algorithms were carried out.CONCLUSION:Starting insulin glargine based on BMI is safe,but fast titration algorithms increase the risk of moderate hypoglycemia.

Comparison on Efficacy and Safety of Three Inpatient Insulin Regimens for Management of Non-Critical Patients with Type 2 Diabetes

Background: Hyperglycemia in hospitalized patients is associated with poor clinical outcomes. Scheduled Subcutaneous Insulin therapy has been recommended for better glycemic control. Aims: To compare efficacy and safety of traditional sliding scale insulin (SSI) versus modified 70/30 insulin versus basal plus supplemental scale (SS) insulin regimens for glycemic control of inpatients with diabetes. Methods: In a prospective trial, 62 patients with diabetes were randomized to receive either hospital SSI (N = 22), or twice daily 70/30 insulin plus supplemental lunchtime insulin for BG ≥ 150 mg/dL (N = 21) or once every night glargine plus prandial glulisine for BG ≥ 150 mg/dL (N = 19). 70/30 insulin and glargine were started respectively at 0.4 and 0.2 U/kg/day for BG ≤ 200 mg/dL or 0.5 and 0.3 U/kg/day for BG above 200 mg/dL. Results: Starting at BG level of 204 ± 68, 200 ± 50 and 241 ± 94 mg/dL in SSI, 70/30 insulin and glargine/glulisine groups respectively, (F(2,35.47) = 1.467, p = 0.244, Welch test), mean daily BG after first day of hospitalization was statistically significant (F(2,35.58) = 7.043, p = 0.003, Welch test) lower in 70/30 insulin group (171 ± 38 mg/dL) compared to (218 ± 71 mg/dL) in SSI group (p = 0.026) and (225 ± 65 mg/dL) in glargine/glulisine group (p = 0.01). Conclusions: With poorly educated nursing staff, basal plus SS insulin failed to provide adequate glycemic control. However, tailored 70/30 insulin regimen resulted in statistically significant glycemic control compared to traditional SSI.

Assessing insulin effectiveness at the end of the day: Once-daily versus twice-daily insulin glargine injection

Objective: Evidence supporting the twice-daily administration of insulin glargine as an approach to address its waning effectiveness at the end of a 24 hour period is sparse. We hypothesized that insulin concentrations determined during the last four hours of a 24 hour period would be greater when identical doses of insulin glargine were administered twice-daily as compared to once-daily among type 1 diabetes patients. Research Methods: Ten subjects with insulin deficient type 1 diabetes were admitted for two 38-hour studies at least one week apart. Patients received full-dose insulin glargine once daily at 0800 and half-dose insulin glargine twice-daily at 0800 and 2000 for at least one week in random order prior to overnight studies. Overnight glucose was stabilized with intravenous insulin on the evening prior to study, and subjects fasted and did not receive short acting insulin during the study period. Insulin concentrations were assessed every 30 minutes with an ultrasensitive assay between study hours 20 and 24. Results: Insulin concentrations for the final four hours of study period did not differ between once-daily and twice-daily insulin glargine administration (p = 0.38). Home glucose testing results and overnight plasma glucose concentrations did not differ between study conditions. Conclusions: These results demonstrate that insulin concentrations are equivalent during the last four hours of a 24-hour period when insulin glargine is administered once- or twice-daily. These findings do not support a role for twice-daily insulin glargine in the management of patients with type 1 diabetes.

Efficacy and Safety of Basal-Supported Prandial GLP-1 Receptor Agonist Therapy

Aim: To assess the safety and efficacy of basal-supported prandial GLP-1 receptor agonist therapy (BPT)* in type 2 diabetes mellitus (T2DM). Methods: Patients with T2DM, who had previously received insulin injection therapy and who had had their treatment switched to BPT (liraglutide), were retrospectively recruited. The efficacy of BPT was assessed by determining changes in HbA1c, body weight and total daily insulin dose from baseline to 4 months after BPT initiation. Safety was assessed by comparing the frequency of hypoglycemic episodes at baseline and after 4 months. The Wilcoxon test was used to analyze changes in parameters throughout the study period. Results: Twenty-nine patients, previously treated with basal-supported oral therapy (BOT), basal-bolus insulin, or pre-mixed insulin, were recruited. When analyzed together, there was no change in HbA1c throughout the study period, but body weight decreased (baseline 68.8 ± 13.2 kg vs. month 4 67.3 ± 13.1 kg;p < 0.001). Total daily insulin dose decreased after 4 months (baseline 24.4 ± 15.5 U/day vs. month 4 14.7 ± 9.2 U/day;p < 0.001), and there was no change in the frequency of hypoglycemic episodes. Analysis was conducted within sub-groups based on previous treatment modality. In the BOT group, HbA1c decreased from baseline after 2 months and body weight did not change throughout the study period. In both the basal-bolus insulin group and the pre-mixed insulin group, HbA1c remained steady throughout and there was a decrease in body weight. No change in the frequency of hypoglycemia was observed in any of the sub-groups. Conclusion: BPT in T2DM was associated with weight loss without changes in glycemic control over 4 months, suggesting that it may be an effective and safe therapy.

Assessment of Safety and Effectiveness of Glaritus^&reg;(Wockhardt’s Insulin Glargine) in a Prospective, Multi-Centric Post Marketing Observational Study in Nepalese Having Type 2 Diabetes Mellitus

Background: Nepal is one of the fastest urbanizing countries in South Asia and is facing the consequences of urban lifestyle leading to obesity and metabolic syndrome. Type 2 diabetes mellitus (T2DM) is currently a high-burden disease in Nepal with a prevalence of 8.4%. Of these 8% - 18% patients are on insulin and 42% patients were reported to have uncontrolled diabetes in the past year. This suggests a need for better therapy options in terms of efficacy and safety. The current study was designed to investigate the effects of Insulin glargine-based therapy in Nepalese with T2DM who could not achieve adequate glycemic control with oral and non-glargine-insulin therapy. Methods: This is a prospective, multi-centric, single arm and post marketing observational study to assess the safety and effectiveness of Glaritus&reg;(Wockhardt’s Insulin Glargine) in 52 T2DM patients from 3 (three) different study sites in Nepal (Bharatpur, Kathmandu and Pokhra) from September 2015 to December 2016. The primary objective of the study was to evaluate the safety of Glaritus&reg;, mainly in terms of hypoglycemia, renal function tests and liver function tests. The secondary objectives were to evaluate the effectiveness of Glaritus&reg;in terms of percentage of patients achieving HbA1c goal of less than 7%, mean changes in HbA1c & fasting plasma glucose (FPG) levels from baseline till the end of study. Results: 3.85% of subjects experienced hypoglycemia during first 3 months of therapy whereas 1.92% had similar experience in next 3 months of therapy. The mean HbA1c values reduced from 9.16% to 7.15% at the end of study. 21.05% of the enrolled subjects achieved the goal of HbA1c &reg;was well tolerated by the study patients. Conclusion: In patients with type 2 diabetes mellitus inadequately controlled on oral hypoglycemic agents and/or insulin, initiation with Glaritus&reg;significantly improved glycemic control with good tolerability and acceptability. This analysis in T2DM Nepalese patients shows that by significantly improving glycemic control while not increasing risk of hypoglycemia, Glaritus&reg;provides safer basal insulin and may be suited to aggressive treatment regimens. From a societal perspective, it will help more patients reach the glycemic control target as recommended by the current treatment guidelines.

Basal or bolus dose, which is the key factor in CSII?

Objective: To observe the value of HbA1c level evaluating the total daily basal insulin dose by continuous subcuta- neous insulin infusion (CSII) in 268 patients with type 2 diabetes mellitus. Methods: 5-point capillary blood glucose was moni- tored in pre- and post-CSII and the insulin dose which could stabilize blood glucose was defined as the total daily dose of insulin, including basal and bolus total dose. Correlation between HbA1c level and total daily dose of insulin in patients with type 2 dia- betes mellitus was analyzed. Correlation between HbA1c level and 5-point capillary blood glucose was also analyzed. Results: Obvious correlation was observed between HbA1c level and the basal total daily dose of insulin if HbA1c was more than 9.3% (r=0.635, P<0.05). The average of 5-point capillary blood glucose was best correlated with HbA1c and fasting blood glucose next best. Conclusion: HbA1c level can forecast basal total daily dose of insulin in CSII.

胰岛素周制剂研究进展:2型糖尿病从基础胰岛素日制剂转换为每周一次依柯胰岛素治疗的疗效

治疗依从性差是糖尿病患者胰岛素起始治疗后血糖控制不佳的重要原因之一,减少注射次数有助于提高依从性。对于已使用胰岛素治疗的糖尿病患者,以依柯胰岛素(insulin icodec)为代表的胰岛素周制剂提供了注射次数更少的治疗方案。现介绍依柯胰岛素的分子结构和作用机制,并基于依柯胰岛素的两项Ⅲa期临床研究(ONWARDS 2和4)的结果,探讨在已使用胰岛素治疗的2型糖尿病患者中转换为依柯胰岛素治疗的有效性和安全性。

基础胰岛素联合口服降糖药治疗效果不佳的2型糖尿病患者的治疗策略选择:伞形评价

目的对基础胰岛素联合一线口服降糖药(二甲双胍/磺脲类药物)治疗效果不佳的2型糖尿病(T2DM)患者的不同治疗策略进行伞形评价,为患者推荐最佳治疗策略提供科学依据。方法计算机检索PubMed、Embase、Cochrane Library、SinoMed、CNKI、WanFang Data和VIP数据库,搜集基础胰岛素联合一线口服降糖药治疗T2DM效果不佳的系统评价(SR)/Meta分析(MA),其原始研究为随机对照试验(RCT),检索时限均从建库至2023年9月13日,由2名研究者独立进行文献筛选、数据提取和文献质量评估,采用R 4.2.2软件中的metaumbrella包进行伞形评价。结果共纳入1篇SR和8篇MA,包括72个RCT,24095例患者,涉及的后续治疗措施有胰高糖素样肽1受体激动剂(GLP-1RA)、二肽基肽酶Ⅳ抑制剂(DPP-4i)、钠葡萄糖共转运蛋白2抑制剂(SGLT-2i)、噻唑烷二酮类药(TZD)等。结果显示,与安慰剂相比,GLP-1RA[WMD=-3.67,95%CI(-5.81,-1.53),P=0.001]、DPP-4i[WMD=-5.56,95%CI(-7.40,-3.73),P<0.001]和SGLT-2i[WMD=-5.34,95%CI(-9.56,-1.13),P=0.013]均可显著降低糖化血红蛋白(%)水平;阳性药物比较中,GLP-1RA vs.甘精胰岛素利司那肽固定比例复方制剂(IGlarLixi)[WMD=7.49,95%CI(7.01,7.92),P<0.001],GLP-1RA vs.德谷胰岛素利拉鲁肽注射液(IDegLira)[WMD=0.83,95%CI(0.11,1.54),P=0.023],显示GLP-1RA的降血糖效果不及IGlarLixi和IDegLira。与安慰剂相比,GLP-1RA可显著减轻体重(kg)[WMD=-3.46,95%CI(-5.30,-1.63),P<0.001];阳性药物比较中,GLP-1RA vs.IGlarLixi[WMD=-8.40,95%CI(-8.86,-7.93),P<0.001],GLP-1RA vs.IDegLira[WMD=-0.53,95%CI(-0.99,-0.07),P=0.025],显示GLP-1RA的降体重效果优于IGlarLixi和IDegLira。与安慰剂相比,TZD[OR=1.51,95%CI(1.11,2.05),P=0.009]和GLP-1RA[OR=1.24,95%CI(1.03,1.49),P=0.023]均会增加低血糖发生风险;阳性药物比较中,GLP-1RA vs.IDegLira[OR=1.22,95%CI(1.04,1.43),P=0.014],显示GLP-1RA导致的低血糖发生风险高于IDegLira。结论后续治疗使用GLP-1RA、DPP-4i、SGLT-2i能更好地控制血糖,且GLP-1RA有降低体重优势,但使用GLP-1RA的患者低血糖风险较高。

基础-餐时胰岛素转换为预混胰岛素治疗2型糖尿病的胰岛素用量关系及预混胰岛素的早晚分配

目的探讨基础-餐时胰岛素(门冬胰岛素注射液+甘精胰岛素注射液)转换为预混胰岛素(门冬胰岛素30注射液)治疗2型糖尿病(T2DM)的胰岛素用量关系及预混胰岛素的早晚分配。方法选取2021年1月至7月西安医学院第一附属医院新诊断和口服药失效的T2DM患者34例,先接受基础-餐时胰岛素治疗,血糖控制达标后转换为预混胰岛素治疗。比较两种方案血糖控制达标时的日均胰岛素用量及日均血糖;分析两种方案日均胰岛素用量的关系及预混胰岛素治疗日均胰岛素用量与早餐前胰岛素用量的关系。结果两种方案血糖控制达标时的日均胰岛素用量比较,差异具有统计学意义(P<0.05);两种方案血糖控制达标时的日均血糖比较,差异无统计学意义(P>0.05)。基础-餐时胰岛素治疗日均胰岛素用量与预混胰岛素治疗日均胰岛素用量呈线性关系,线性回归方程为y_(1)=-1.848+0.907x_(1)(R^(2)=0.873,P<0.01);预混胰岛素治疗日均胰岛素用量与早餐前胰岛素用量呈线性关系,线性回归方程为y_(2)=1.387+0.56x_(2)(R^(2)=0.883,P<0.01)。结论治疗T2MD由基础-餐时胰岛素转换为预混胰岛素时,日均胰岛素用量可调整为90%,预混胰岛素的早晚剂量可按60%、40%分配。

初诊糖尿病患者对初始基础胰岛素治疗的认知及低血糖经历调查分析

目的调查初诊糖尿病患者对初始基础胰岛素治疗的认知及低血糖经历,为提升初诊糖尿病患者的相关认知及预防低血糖发生提供参考。方法回顾性分析314例初诊糖尿病患者的临床资料,统计随访期间患者低血糖事件的发生情况以及对初始基础胰岛素治疗的认知水平,单因素分析影响低血糖事件发生的相关因素,多因素Logistic回归分析低血糖事件发生的独立危险因素。结果随访1年内,314例初诊糖尿病患者中有135例发生过749次低血糖事件,总发生率为42.99%;749次低血糖事件中,轻度低血糖占比最高(73.03%),0:00—6:00低血糖事件发生率最高(48.33%)。经历低血糖发生的患者对初始基础胰岛素治疗的认知评分低于无低血糖经历者,差异有统计学意义(P<0.05);单因素分析结果显示,年龄、BMI、文化程度、是否合并高血压、遵医行为、对初始基础胰岛素治疗认知评分与低血糖的发生相关(P<0.05);多因素分析结果显示,年龄≥60岁、BMI<24.0 kg/m 2、遵医行为表现较差、对初始基础胰岛素治疗认知评分<25分是低血糖发生的独立危险因素(P<0.05)。结论初诊糖尿病患者对初始基础胰岛素治疗的认知水平越高,发生低血糖事件的风险越低,应重视夜间低血糖的发生;高龄、低BMI、遵医行为差、治疗认知水平低者易发生低血糖。

利司那肽联合基础胰岛素与餐时-基础胰岛素治疗2型糖尿病疗效对比

目的 对比分析利司那肽联合基础胰岛素与餐时-基础胰岛素治疗2型糖尿病疗效。方法 选取2021年1月—2022年12月台山市人民医院收治的80例2型糖尿病患者为研究对象,按照随机数表法分为两组,各40例。对照组治疗方案为餐时-基础胰岛素(门冬胰岛素+甘精胰岛素),观察组治疗方案为利司那肽+基础胰岛素(甘精胰岛素)。比较两组治疗效果。结果 观察组治疗总有效率(97.50%)高于对照组(82.50%),差异有统计学意义(P<0.05)。治疗前,两组血糖指标对比,差异无统计学意义(P>0.05);治疗后,两组空腹血糖、餐后血糖、糖化血红蛋白水平均明显降低,且观察组降低幅度大于对照组,差异有统计学意义(P<0.05);治疗前,两组各项胰岛功能指标对比,差异无统计学意义(P>0.05);治疗后,两组空腹胰岛素水平、空腹C肽均明显升高,且观察组升高幅度大于对照组,差异有统计学意义(P<0.05)。结论 利司那肽+基础胰岛素是2型糖尿病优质的联合治疗方案,可有效控制血糖,改善胰岛功能。

胰岛素泵校准方法研究

目的:研究胰岛素泵校准方法,避免因微量胰岛素输注误差而造成相关不良事件的发生。方法:基于研制的胰岛素泵校准装置,通过提出胰岛素泵校准方法,确定主要计量特性指标,结合校准案例进行验证,并对不良反应事件和影响系统安全的因素进行分析。结果:依据校准方法对胰岛素泵的大剂量示值误差、基础率示值误差分别为1.46%、-1.28%,阻塞压力示值误差为-4.43 kPa,极限温度示值误差为1.6℃,其验证结果均符合要求。结论:成功建立的胰岛素泵校准方法可为《胰岛素泵校准规范》的编写提供有益参考,有助于促进胰岛素泵量值溯源和标准化的实现,加强胰岛素泵的全过程监管。

基于网络平台的个体化随访指导在基础胰岛素患者中的应用分析

目的:基于网络平台的个体化随访指导对初次使用基础胰岛素患者的血糖控制效果及依从性分析。方法:对大理大学第一附属医院2018年1月至2019年5月初次使用基础胰岛素的539例患者进行网络平台个体化随访指导,回顾性分析患者的一般资料及随访各阶段患者的血糖监测数据等,并对其中多个因素进行多重线性回归分析。结果:在随访期内,空腹血糖达标率为(69.73±3.25)%,餐后2 h血糖达标率为(74.63±1.49)%;多重线性回归分析发现,初始空腹血糖与初始胰岛素剂量具有相关性(P<0.05),入组时餐后2 h血糖与病程、年龄、体质指数具有相关性(P<0.05)。结论:基于网络平台的个体化随访指导可以改善初次使用胰岛素患者的血糖控制效果,提高患者胰岛素用药依从性。

基础胰岛素联合阿卡波糖对初诊老年糖尿病患者血糖水平及并发症的影响

目的：分析基础胰岛素联合阿卡波糖对初诊老年糖尿病患者血糖水平及并发症情况的影响。方法：2012年7月~2015年1月间河北医科大学第一医院收治的初诊老年糖尿病患者135例作为研究对象,按照治疗方式不同分为观察组66例,对照组69例。对照组患者接受单纯阿卡波糖治疗,观察组患者接受基础胰岛素联合阿卡波糖治疗,对比两组患者的血糖水平、氧化应激指标、神经传导速度、血管损伤及炎症因子水平等差异。结果：治疗后观察组患者的FPG、2hPG、HbA1C水平低于对照组患者（P〈0.05）;AGE-P、MDA、NADPH水平低于对照组患者,SOD水平高于对照组患者（P〈0.05）;正中MNCV、尺MNCV、胫MNCV、正中SNCV、腓SNCV水平高于对照组患者（P〈0.05）;sVCAM-1、hsCRP、IL-6水平低于对照组患者（P〈0.05）。结论：初诊老年糖尿病患者接受基础胰岛素联合阿卡波糖治疗,可以有效优化血糖及并发症相关因子水平,具有积极的临床意义。

基础胰岛素起始联合口服药治疗2型糖尿病112例临床分析

目的观察基础胰岛素起始联合口服药治疗2型糖尿病(T2DM)患者转归、有效性和安全性。方法选取T2DM患者112例,所有患者纳入研究时口服药血糖控制不达标,起始采用基础胰岛素,并根据血糖监测结果调整胰岛素用量,口服药维持原剂量,治疗24w,观察患者治疗前后空腹血糖(FBG)、餐后2小时血糖(2hPG)、糖化血红蛋白(HbAlc)、体质量指数(BMI)等变化及低血糖发生情况。结果治疗24w后,血糖控制达标率72%,FBG、2hPG和HbAlc水平较前明显下降,差异有统计学意义(P<0.01);BMI水平较前略有下降,但差异无统计学意义(P>0.05)。治疗期间11例受试者发生低血糖事件12次,均为一般性低血糖。结论基础胰岛素起始联合口服药治疗T2DM达标率高,治疗效果确切,低血糖发生率低,且病人依从性良好,是门诊治疗的首选方案。

基础胰岛素联合二甲双胍治疗2型糖尿病的短期疗效和安全性观察

目的对口服降糖药不能很好控制血糖的2型糖尿病患者,改用二甲双胍联合(重组)甘精胰岛素(来得时、长秀霖)或诺和灵N治疗,比较3种治疗方案的疗效和安全性。方法将63例符合标准的2型糖尿病患者分为3组,分别给予诺和灵N(n=23)、来得时(n=20)、长秀霖(n=20)睡前皮下注射,三组均联合二甲双胍口服。观察住院期间空腹血糖的变化和胰岛素剂量及低血糖发生率。结果治疗后三组空腹血糖均明显下降(P<0.05),但组间比较差异无统计学意义。来得时组和诺和灵N组、来得时组和长秀霖组在出院时单位体重胰岛素用量相似,长秀霖组较诺和灵N组在出院时单位体重胰岛素用量多(P=0.017)。(重组)甘精胰岛素组低血糖发生率明显低于诺和灵N组(P<0.05)。结论对口服降糖药控制不佳的2型糖尿病患者,应用二甲双胍联合来得时或长秀霖治疗的疗效和安全性相似;来得时的短期疗效和NPH相似;来得时和长秀霖较诺和灵N有更安全的降糖效果。