Individualized intensive insulin therapy of diabetes: Not only thegoal, but also the time

Intensive insulin therapy has been extensively used to control blood glucose levels because of its ability to reduce the risk of chronic complications of diabetes.According to current guidelines,intensive glycemic control requires individu-alized glucose goals rather than as low as possible.During intensive therapy,rapid blood glucose reduction can aggravate microvascular and macrovascular complications,and prolonged overuse of insulin can lead to treatment-induced neuropathy and retinopathy,hypoglycemia,obesity,lipodystrophy,and insulin antibody syndrome.Therefore,we need to develop individualized hypoglycemic plans for patients with diabetes,including the time required for blood glucose normalization and the duration of intensive insulin therapy,which deserves further study.

Influence of Intensive Insulin Therapy on Vascular Endothelial Growth Factor in Patients with Severe Trauma

The influence of early-stage intensive insulin therapy on the plasma levels of vascular en- dothelial growth factor （VEGF） and the related parameters in patients with severe trauma and the clini- cal implication were investigated. Sixty-four cases of severe trauma （injury severity score 〉20） with stress hyperglycemia （blood glucose 〉9 mmol/L） were randomly divided into intensive insulin therapy group and conventional therapy group. ELISA method, radioimmunoassay and density gradient grada- tion one-step process were used to determine plasma VEGF, endothelin-1 （ET-1）, and the number of circulating endothelial cells （CECs） at the day of 0, 2, 3, 5 and 7 after admission. Simultaneously, the changes of CRP concentration in plasma were monitored to evaluate inflammatory response. The results showed that plasma levels of observational indexes in patients receiving early-stage intensive insulin therapy were all significantly lower than those in conventional therapy groups 2, 3, 5 and 7 days after admission [for VEGF （ng/L）, 122.2±23.8 vs. 135.9±26.5, 109.6±27.3 vs. 129.0±18.4, 88.7±18.2 vs. 102.6±27.3, 54.2±26.4 vs. 85.7±35.2, P〈0.05, 0.01, 0.05, 0.05 respectively; for ET-1 （ng/L）, 162.8±23.5 vs. 173.7±13.2, 128.6±17.5 vs. 148.8±22.4, 96.5±14.8 vs. 125.7±14.8, 90.7±16.9 vs. 104.9±22.5, P〈0.05, 0.01, 0.01, 0.01 respectively; for CRP （mg/L）, 23.2±13.8 vs. 31.9±16.5, 13.6±17.3 vs. 23.5±18.4, 8.7±10.2 vs. 15.6±13.3, 5.2±9.4 vs. 10.7±11.2, all P〈0.05; for CECs （/0.9 μL）, 10.9±5.6 vs. 13.9±6.2, 8.5±4.9 vs. 11.3±5.3, 6.3±6.4 vs. 9.4±5.7, 4.8±7.1 vs. 7.8±4.8, all P〈0.05]. It was concluded that intensive insulin therapy could antagonize the endothelium injury after trauma and reduce inflammation response quickly, which was one of important mechanisms by which intensive insulin therapy improves the prognosis of trauma patients.

Clinical Effects of Intensive Insulin Therapy Treating Traumatic Shock Combined with Multiple Organ Dysfunction Syndrome

The therapeutic effects of intensive insulin therapy in treatment of traumatic shock combined with multiple organ dysfunction syndrome （MODS） were investigated. A total of 114 patients with traumatic shock combined with MODS were randomly divided into two groups： control group （n=56） treated with conventional therapy, and intensive insulin therapy group （n=58） treated with conventional therapy plus continuous insulin pumping to control the blood glucose level at range of 4.4-6.1 mmol/L. White blood cells （WBC） counts, prothrombin time （PT）, serum creatinine （SCr）, alanine aminotransferase （ALT）, serum albumin and PaO2 were measured before and at the day 1, 3, 5, 7 and 14 after treatment. The incidence of gastrointestinal dysfunction, the incidence of MODS, hospital stay and the mortality were also observed and compared. After intensive insulin therapy, the WBC counts, SCr, ALT and PT were significantly reduced （P0.05）, but the level of serum albumin was significantly increased （P0.05） at the day 3, 5, 7 and 14. In the meantime, the PaO2 was significantly elevated at the day 3, 5 and 7 （P0.01） after intensive insulin therapy. The incidence of gastrointestinal dysfunction, the incidence of MODS, the length of hospital stay and the mortality were markedly decreased （P0.01）. The results suggest early treatment with intensive insulin therapy is effective for traumatic shock combined with MODS and can decrease the length of hospital stay and the mortality.

Effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing gastrectomy

AIM: To investigate the effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing radical distal gastrectomy. METHODS: Within 24 h of intensive care unit management, patients with gastric cancer were enrolled after written informed consent and randomized to the intensive insulin therapy (IIT) group to keep glucose levels from 4.4 to 6.1 mmol/L or the conventional insulin therapy (CIT) group to keep levels less than 10 mmol/L. Resting energy expenditure (REE), respiratory quotient (RQ), resting energy expenditure per kilogram (REE/kg), and the lipid oxidation rate were monitored by the indirect calorimeter of calcium citrate malate nutrition metabolism investigation system. The changes in body composition were analyzed by multi-frequency bioimpedance analysis. Blood fasting glucose and insulin concentration were measured for assessment of Homeostasis model assessment of insulin resistance. RESULTS: Sixty patients were enrolled. Compared with preoperative baseline, postoperative REE increased by over 22.15% and 11.07%; REE/kg rose up to 27.22 ± 1.33 kcal/kg and 24.72 ± 1.43 kcal/kg; RQ decreased to 0.759 ± 0.034 and 0.791 ± 0.037; the lipid oxidation ratio was up to 78.25% ± 17.74% and 67.13% ± 12.76% supported by parenteral nutrition solutions from 37.56% ± 11.64% at the baseline; the level of Ln-HOMA-IR went up dramatically (P < 0.05, respectively) on postoperative days 1 and 3 in the IIT group. Meanwhile the concentration of total protein, albumin and triglyceride declined significantly on postoperative days 1 and 3 compared with pre-operative levels (P < 0.05, respectively). Compared with the CIT group, IIT reduced the REE/kg level (27.22 ± 1.33 kcal/kg vs 29.97 ± 1.47 kcal/kg, P = 0.008; 24.72 ± 1.43 kcal/kg vs 25.66 ± 1.63 kcal/kg, P = 0.013); and decreased the Ln-HOMA-IR score (P = 0.019, 0.028) on postoperative days 1 and 3; IIT decreased the level of CRP on postoperative days 1 and 3 (P = 0.017, 0.006); the total protein and albumin concentrations in the IIT group were greater than those in the CIT group (P = 0.023, 0.009). Postoperative values of internal cell fluid (ICF), fat mass, protein mass (PM), muscle mass, free fat mass and body weight decreased obviously on postoperative 7th day compared with the preoperative baseline in the CIT group (P < 0.05, respectively). IIT reduced markedly consumption of fat mass, PM and ICF compared with CIT (P = 0.009 to 0.026). CONCLUSION: There were some benefits of IIT in decreasing the perioperative insulin resistance state, reducing energy expenditure and consumption of proteins and lipids tissue in patients undergoing gastrectomy.

Efficacy and Safety of Insulin Glulisine in Intensive Insulin Therapy: Bolus Insulin Adjust Nice Control by apiDRA Study (BANDRA Study)

Background: Treatment for postprandial glycemia using rapid-acting insulin analogues sometimes resulted in preprandial hypoglycemia or weight gain. Objective: This study evaluated the efficacy and safety of switching bolus insulin from insulin lispro (Lis) to insulin glulisine (Glu) in patients with inadequately controlled diabetes on intensive insulin therapy with Lis and glargine (Gla). Methods: Seventy-two outpatients with inadequate glycemic control (glycated hemoglobin [HbA1c] ≥7.0%, glycated albumin [GA] ≥20%) on intensive insulin therapy comprising Lis and Gla for ≥24 weeks were enrolled. We switched treatment from Lis to Glu with a stepwise increase in the dose by 1 unit per meal to obtain a GA level of ≤20% for 24 weeks, and the efficacy and safety were evaluated. Patients’ treatment satisfaction was also evaluated using the Diabetes Treatment Satisfaction Questionnaire (DTSQ) after the treatment. Results: After switching from Lis to Glu, both HbA1c and GA levels significantly lowered from 8.26% ± 0.13% to 7.71% ± 0.13% (P < 0.01) and from 23.9% ± 1.8% to 21.4% ± 1.9% (P < 0.01), respectively. Furthermore, switching from Lis to Glu improved patients’ treatment satisfaction;scores for 7 of the 8 items, such as “satisfaction” and “convenience” were significantly improved (P < 0.001), with no significant change in the scores for “improvement of hypoglycemia” (P = 0.91). Conclusions: Our present study suggests that switching bolus insulin from Lis to Glu by the addition of 1 unit of Glu per meal may be a useful treatment option for patients with inadequate glycemic control receiving intensive insulin therapy with Lis and Gla.

Intensive Insulin Therapy Has No Effect on Mortality and Morbidity in Cardiac Surgery Patients: A Meta-Analysis

Introduction: Optimal glycemic control in cardiac surgery patients remains a laudable but confusing practice. Existing studies have primarily employed two maintenance strategies using either intensive insulin therapy (IIT) (maintain glucose p = 0.628), ICU LOS (MD = -0.073 days, 95% CI = -0.324 to 0.178;p = 0.568), or hospital LOS (MD = 0.269, 95% CI = -2.158 to 2.696;p = 0.828). No difference in AF rates (RR = 0.887, 95% CI = 0.681 to 1.155;p = 0.375) or deep sternal infection (RR = 0.985, 95% CI = 0.357 to 2.720;p = 0.977) were observed. Conclusion: IIT targeting blood sugar levels of 80 - 120 mg/dl have no effect on perioperative outcomes in cardiac surgery patients. IIT is associated with similar mortality, ICU LOS, hospital LOS, AF rates, and deep sternal infection rates compared to more liberal glycemic strategies. IIT should not replace CIT as the standard of care in cardiac surgery patients.

Short acting insulin analogues in intensive care unit patients

Blood glucose control in intensive care unit(ICU) patients, addressed to actively maintain blood glucose concentration within defined thresholds, is based on two major therapeutic interventions: to supply an adequate calories load and, when necessary, to continuously infuse insulin titrated to patients needs: intensive insulin therapy(IIT). Short acting insulin analogues(SAIA) have been synthesized to improve the chronic treatment of patients with diabetes but, because of the pharmacokinetic characteristics that include shorter onset and off-set, they can be effectively used also in ICU patients and have the potential to be associated with a more limited risk of inducing episodes of iatrogenic hypoglycemia. Medical therapies carry an intrinsic risk for collateral effects; this can be more harmful in patients with unstable clinical conditions like ICU patients. To minimize these risks, the use of short acting drugs in ICU patients have gained a progressively larger room in ICU and now pharmaceutical companies and researchers design drugs dedicated to this subset of medical practice. In this article we report the rationale of using short acting drugs in ICU patients(i.e., sedation and treatment of arterial hypertension) and we also describe SAIA and their therapeutic use in ICU with the potential to minimize iatrogenic hypoglycemia relatedto IIT. The pharmacodynamic and pharmachokinetic characteristics of SAIA will be also discussed.

Perioperative insulin therapy using a closed-loop artificial endocrine pancreas after hepatic resection

Postoperative hyperglycemia is common in critically ill patients, even in those without a prior history of diabetes mellitus. It is well known that hyperglycemia induced by surgical stress often results in dysregulation of liver metabolism and immune function, impairing postoperative recovery. Current evidence suggests that maintaining normoglycemia postoperatively improves surgical outcome and reduces the mortality and morbidity of critically ill patients. On the basis of these observations, several large randomized controlled studies were designed to evaluate the benefit of postoperative tight glycemic control with intensive insulin therapy. However, intensive insulin therapy carries the risk of hypoglycemia, which is linked to serious neurological events. Recently, we demonstrated that perioperative tight glycemic control in surgical patients could be achieved safely using a closed-loop glycemic control system and that this decreased both the incidence of infection at the site of the surgical incision, without the appearance of hypoglycemia, and actual hospital costs. Here, we review the benefits and requirements of perioperative intensive insulin therapy using a dosed-loop artificial endocrine pancreas system in hepatectomized patients. This novel intensive insulin therapy is safe and effectively improves surgical outcome after hepatic resection.

Conventional insulin vs insulin infusion therapy in acute coronary syndrome diabetic patients

AIM:To evaluate the impact on glucose variability(GLUCV)of an nurse-implemented insulin infusion protocol when compared with a conventional insulin treatment during the day-to-day clinical activity.METHODS:We enrolled 44 type 2 diabetic patients(n=32 males;n=12 females)with acute coronary syndrome(ACS)and randomy assigned to standard a subcutaneous insulin treatment(n=23)or a nurse-implemented continuous intravenous insulin infusion protocol(n=21).We utilized some parameters of GLUCV representing well-known surrogate markers of prognosis,i.e.,glucose standard deviation(SD),the mean dailyδglucose(mean of daily difference between maximum and minimum glucose),and the coefficient of variation(CV)of glucose,expressed as percent glucose(SD)/glu-cose(mean).RESULTS:At the admission,first fasting blood glucose,pharmacological treatments(insulin and/or anti-diabetic drugs)prior to entering the study and basal glycated hemoglobin(HbA1c)were observed in the two groups treated with subcutaneous or intravenous insulin infusion,respectively.When compared with patients submitted to standard therapy,insulin-infused patients showed both increased first 24-h(median 6.9 mmol/L vs 5.7mmol/L P<0.045)and overall hospitalizationδglucose(median 10.9 mmol/L vs 9.3 mmol/L,P<0.028),with a tendency to a significant increase in first 24-h glycaemic CV(23.1%vs 19.6%,P<0.053).Severe hypoglycaemia was rare(14.3%),and it was observed only in 3 patients receiving insulin infusion therapy.HbA1c values measured during hospitalization and 3 mo after discharge did not differ in the two groups of treatment.CONCLUSION:Our pilot data suggest that no real benefit in terms of GLUCV is observed when routinely managing blood glucose by insulin infusion therapy in type 2 diabetic ACS hospitalized patients in respect to conventional insulin

Blood glucose control in the intensive care unit: Where is the data?

Blood glucose control, including hyperglycemia correction, maintaining glucose at optimal level and avoiding hypoglycemia, is a challenge clinicians face every day in intensive care units (ICUs). If managed inadequately, its related mortality can increase. Prior to 2001, no relevant data from randomized, controlled studies assessing glucose control in the ICU were available. In the past 18 years, however, many clinical trials have defined criteria for managing abnormal blood glucose levels, as well as provided suggestions for glycemic monitoring. Point-ofcare blood glucose monitors have become the preferred bedside technology to aid in glycemic management. In addition, in some institutions, continuous glucose monitoring is now available. Cost-effectiveness of adequate glycemic control in the ICU must be taken into consideration when addressing this complex issue. Newer types of glycemic monitoring may reduce nursing staff fatigue and shorten times for the treatment of hyperglycemia or hypoglycemia. There are a variety of glycemic care protocols available. However, not all ICU clinicians are aware of them. The following minireview describes some of these concepts.

2型糖尿病患者胰岛素泵强化治疗中标准化护理的应用效果

目的探究标准化护理在2型糖尿病(T2DM)患者胰岛素泵强化治疗期间的应用效果。方法选取2022年12月至2023年12月在本院开展胰岛素泵强化治疗的90例T2DM患者为主要观察对象,按照随机数字表法分成两组,分别有45例。对照组采取常规护理,观察组采取标准化护理。评估两组血糖值、糖尿病自我管理行为量表(SDSCA)评分、糖尿病特异性生存质量量表(A-DQOL)评分改善情况及不良事件控制效果。结果出院首日,两组空腹血糖(FBG)、餐后2 h血糖(2 hPG)均低于干预首日,且观察组FBG、2 hPG均低于对照组(P<0.05)。出院当日,观察组SDSCA总分高于对照组(P<0.05);A-DQOL总分比较,观察组比对照组低(P<0.05)。干预期间不良事件总发生率比较,观察组比对照组低(P<0.05)。结论于T2DM患者胰岛素泵强化治疗期间实施标准化护理,可使其主动改善不利于降糖的行为,提高降糖效果,规避可能影响降糖效果的不利因素,提升其生存质量。

强化胰岛素治疗对急性心肌梗死患者的预后影响

目的系统评价强化胰岛素治疗应用于急性心肌梗死患者的临床疗效和安全性,为改善预后提供参考。方法对Cochrane、Embase、PubMed、中国知网、万方数据知识服务平台、中文科技期刊数据库、CBM数据库自建库至2022年10月的相关文献进行系统检索,以确定比较强化胰岛素治疗和普通胰岛素治疗对急性心肌梗死患者的临床预后影响的随机对照试验。提取每项研究的数据和特征,采用RevMan 5.4软件进行荟萃分析。结果最终纳入8篇文献,共包含726例患者,其中强化胰岛素治疗组372例、普通胰岛素治疗组354例。对各组数据进行荟萃分析显示,强化胰岛素治疗组主要心血管不良事件发生率(RR=0.53,95%CI=0.44~0.64,P<0.001)、全因死亡率(RR=0.51,95%CI=0.33~0.78,P=0.002)、治疗7 d超敏C反应蛋白(WMD=-2.00,95%CI=-2.17~-1.83,P<0.001)均显著低于普通胰岛素治疗组,治疗30 d左心室射血分数(WMD=3.94,95%CI=2.45~5.43,P<0.001)、低血糖事件发生率(RR=2.96,95%CI=1.12~7.83,P=0.030)均显著高于普通胰岛素治疗组,两组经皮冠状动脉介入治疗术后无复流事件差异无统计学意义(RR=0.39,95%CI=0.14~1.13,P=0.080)。结论强化胰岛素治疗可能与急性心肌梗死患者的临床获益相关,但需要更多研究来证实。

短期胰岛素泵强化治疗脑卒中合并2型糖尿病患者的临床效果

目的探讨短期胰岛素泵强化治疗脑卒中合并2型糖尿病(T2DM)患者的临床效果。方法选取许昌市人民医院在2019年3月至2020年3月期间收治的70例脑卒中合并T2DM患者作为研究对象,按照随机数字表法分为研究组(35例)和对照组(35例),对照组给予皮下注射胰岛素降糖治疗,研究组给予行胰岛素泵强化降糖治疗。治疗2周后,比较两组患者临床疗效、血糖控制情况、胰岛功能及运动功能。结果研究组治疗有效率(94.29%)高于对照组(71.43%),差异有统计学意义(P<0.05)。治疗后,两组空腹血糖(FPG)、餐后2 h血糖(2hPG)水平低于治疗前,且研究组水平低于对照组,差异有统计学意义(P<0.05)。治疗后,两组胰岛素曲线下面积(AUC)、胰岛β细胞功能指数(HOMA-β)高于治疗前,且研究组高于对照组,差异有统计学意义(P<0.05)。治疗后,两组Fugl-Meyer运动功能评定量表(FMA)评分高于治疗前,且研究组评分高于对照组,差异有统计学意义(P<0.05)。结论脑卒中合并T2DM患者实施短期胰岛素泵强化治疗,可控制血糖水平,提高胰岛功能、运动功能。

胰岛素强化治疗的2型糖尿病患者低血糖的危险因素分析

目的分析2型糖尿病(Type 2 Diabetes Mellitus,T2DM)患者接受胰岛素强化治疗时诱发其低血糖的危险因素。方法回顾性选取2020年5月—2022年5月于武威市天祝藏族自治县人民医院接受胰岛素强化治疗的210例T2DM患者的临床资料,按照是否存在低血糖现象分为发生组(n=42)和未发生组(n=168)。进行问卷调查(临床基线资料调查问卷等)及血液生化检测,对调查及检测结果展开单因素、Logistic多因素分析。结果单因素分析结果显示,年龄、糖尿病病程、体质指数、C肽、肌酐、白蛋白均与胰岛素强化治疗的T2DM患者发生低血糖相关,差异有统计学意义(P均<0.05)。Logistic回归分析结果显示,胰岛素强化治疗的T2DM患者低血糖发生的危险因素包括年龄(>60周岁)、体质指数(≤21 kg/m^(2))和糖尿病病程(>5年),差异有统计学意义(P均<0.05)。结论年龄、体质指数、糖尿病病程均为导致T2DM患者在胰岛素强化治疗中产生低血糖的危险因素。

度拉糖肽与利拉鲁肽应用于初诊2型糖尿病患者短期胰岛素强化治疗的有效性与安全性研究

目的评估度拉糖肽与利拉鲁肽对初诊2型糖尿病(T2DM)患者短期胰岛素强化治疗的效果与后续结果的影响。方法采用双向性观察研究,收集2022年在东莞市松山湖中心医院进行胰岛素强化治疗的初诊T2DM伴高血糖状态患者,分为度拉糖肽组和利拉鲁肽组,并对住院期间数据和出院后16周的随访数据以及治疗方案进行统计分析。结果共收集到128例符合纳排标准的患者,其中利拉鲁肽组65例,度拉糖肽组63例。①住院期间,度拉糖肽组血糖达标时间更短(P<0.05),并且需胰岛素序贯治疗率更低(P<0.05)。②出院1、4、10、12、13~16周度拉糖肽组血糖均低于利拉鲁肽组,第12周后,度拉糖肽组的空腹及餐后血糖、糖化血红蛋白、空腹血浆血糖均低于利拉鲁肽组(P<0.05),且两组研究药物使用时长差异无统计学意义(P>0.05)。③治疗期间未观察到严重不良反应,主要不良反应为恶心、呕吐、便秘、腹泻、低血糖,两组总体不良反应发生率差异无统计学意义(P>0.05)。结论度拉糖肽与利拉鲁肽应用于短期胰岛素强化治疗,安全性均较好。度拉糖肽组降糖时间更短,出院方案更简单,且随着时间延长降糖效果更显著。度拉糖肽应用于胰岛素强化方案可能更适合初诊T2DM伴有高血糖状态患者。

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。

糖尿病合并急性脑梗死患者采取胰岛素强化治疗的效果及对血糖水平的影响

目的分析糖尿病合并急性脑梗死患者采取胰岛素强化治疗的疗效。方法回顾性选取2022年6月—2023年12月福建医科大学附属龙岩第一医院收治的102例糖尿病合并急性脑梗死患者的临床资料,根据治疗方法不同分为两组,各51例。对照组采用常规治疗,研究组采用胰岛素强化治疗。比较两组临床疗效、血糖水平、胰岛功能。结果研究组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗后,研究组空腹血糖、餐后2 h血糖水平均低于对照组,差异有统计学意义(P均<0.05)。治疗后,研究组空腹胰岛素、胰岛素抵抗指数低于对照组,胰岛β细胞功能指数高于对照组,差异有统计学意义(P均<0.05)。结论糖尿病合并急性脑梗死患者采取胰岛素强化治疗能够降低血糖水平、改善胰岛功能,提高临床疗效。

阶梯式治疗与早期胰岛素强化治疗2型糖尿病的效果比较

目的将阶梯式治疗与早期胰岛素强化治疗2型糖尿病的效果及对其血糖血脂水平、胰岛功能及不良反应发生率的影响进行对照分析。方法选取2021年11月至2022年10月辽宁省健康产业集团铁煤总医院内分泌科收治的80例2型糖尿病患者作为研究对象,按照随机数字表法分为研究组(40例)与常规组(40例),常规组采用阶梯式治疗方案,研究组采用接受早期胰岛素强化治疗。比较两组患者的血糖水平、血脂水平、胰岛功能及不良反应发生率。结果两组患者不良反应总发生率比较,差异无统计学意义(P>0.05);研究组的血糖水平、血脂水平低于常规组,差异有统计学意义(P<0.05);研究组的HOMA-β水平高于常规组,研究组HOMA-IR水平低于常规组,差异有统计学意义(P<0.05)。结论对2型糖尿病患者给予早期胰岛素强化治疗可有效控制患者血糖水平,使其胰岛功能得到了有效的改善。

胰岛素泵强化治疗对妊娠糖尿病患者血清学指标及妊娠结局的影响

目的探讨胰岛素泵强化治疗妊娠糖尿病(Gestational diebetes mellitus,GDM)患者的效果。方法选取2021年7月—2023年6月福建省上杭县妇幼保健院收治的86例GDM患者为研究对象,按随机抽签法分为对照组(43例,多次皮下注射胰岛素治疗)与观察组(43例,胰岛素泵强化治疗),共治疗4周。对比两组血糖指标、血清学指标及不良妊娠结局。结果治疗4周后,两组空腹血糖、餐后2 h血糖均较治疗前降低,且观察组低于对照组,差异有统计学意义(P均<0.05);观察组血糖达标率较对照组高,差异有统计学意义(P<0.05)。两组血清胱抑素C、同型半胱氨酸均较治疗前降低,且观察组低于对照组,差异有统计学意义(P均<0.05)。观察组不良妊娠结局总发生率为4.65%,较对照组的18.60%低,差异有统计学意义(P<0.05)。结论胰岛素泵强化治疗能够有效降低GDM患者血糖水平、血清胱抑素C水平、同型半胱氨酸水平,促使其血糖快速达标,改善妊娠结局。