Objective:To evaluate the meta-analysis of evaluate the clinical efficacy and safety of insulin deside in improving pregnancy with diabetes,and to conduct a Meta-analysis study on the treatment of pregnancy with diabe...Objective:To evaluate the meta-analysis of evaluate the clinical efficacy and safety of insulin deside in improving pregnancy with diabetes,and to conduct a Meta-analysis study on the treatment of pregnancy with diabetes.Methods:Before this study,we comprehensively and systematically searched the major literature websites at home and abroad.From the establishment of the database to January 9,2022,we searched the Chinese and English literature on the randomized controlled trial(RCT)of insulin detemir in the treatment of pregnancy complicated with diabetes.We screened them in strict accordance with the acceptance criteria.The bias risk assessment tool in Cochrane system evaluator manual 5.1.0 was used to evaluate the quality of the selected literature,and the Review Manager 5.4 software was used for meta-analysis.Results:Finally,24 RCTs target literatures were obtained,with a cumulative sample size of 2,362 cases.The results of meta-analysis showed that the reduction range of fasting blood glucose,2 h postprandial blood glucose and glycosylated hemoglobin in patients with insulin detemir combined with routine treatment was greater than that in the control group(P<0.05);compared with conventional treatment,the incidence of premature delivery,macrosomia and cesarean section of the diabetes group were lower than those of the control group(P<0.05).Among them,preterm birth(RR=0.44,95%CI[0.28,0.68],P=0.0002),macrosomia(RR=0.35,95%CI[0.21,0.59],P<0.0001),cesarean section(RR=0.82,95%CI[0.72,0.94],P=0.005),fasting blood glucose(SMD=-1.21,95%CI[-1.54,-0.88],P<0.00001),2 h postprandial blood glucose(SMD=-1.63,95%CI[-1.91,-1.35],P<0.00001),glycosylated hemoglobin(SMD=-2.41,95%CI[-3.12,-1.70],P<0.00001).Conclusion:Routine treatment can improve the clinical effect of pregnancy with diabetes.However,there are low limits on the reference level of this study,so this conclusion has some limitations.展开更多
The success of a specific treatment is traditionally judged according to parameters such as HbA1c. However, other, patient-reported outcomes (PRO) of (insulin) therapy, become increasingly more important. The introduc...The success of a specific treatment is traditionally judged according to parameters such as HbA1c. However, other, patient-reported outcomes (PRO) of (insulin) therapy, become increasingly more important. The introduction of (basal) insulin-analogues could possibly improve PRO, particularly “quality of life”. Direct comparative studies between once daily insulin glargine and once to twice or twice daily insulin detemir have previously shown differences in insulin dosage, dosing frequency and weight gain. Whether this leads to a difference in quality of life in patients who are transferred from insulin detemir to insulin glargine remains to be determined. To establish the effect of insulin glargine on quality of life and patient satisfaction in patients with DM2 who are in poor metabolic control with a (human) basal insulin, a large prospective, observational study in Dutch daily practice was performed. The results of the patient population switched from NPH-insulin to insulin glargine have been published previously. In this article the results of the group of patients treated with insulin detemir before the observation period are described. The results of this observational study show that changing basal insulin therapy to insulin glargine in patients with DM2 who are in poor glycemic control with insulin detemir leads to a clinically significant improvement of glycemic control as well as emotional wellbeing, despite a small increase in weight. Whether other factors such as decreased dosing frequency play a role remains to be determined by future studies.展开更多
Background: Iowa Care (Iowa Medicaid in State of Iowa, USA), switched insulin glargine to detemir in subjects with Diabetes Mellitus (DM) without the knowledge or approval of healthcare providers beginning 8/2006.Impa...Background: Iowa Care (Iowa Medicaid in State of Iowa, USA), switched insulin glargine to detemir in subjects with Diabetes Mellitus (DM) without the knowledge or approval of healthcare providers beginning 8/2006.Impact of this transition in subjects with Type 1 DM is recently reported. Objective: To examine the impact of this transition on various parameters of diabetes management in Type 2 DM. Subjects and Methods: A retrospective review of the records of subjects with Type 2 DM was conducted until 8/2007 in whom the transition had occurred. Only those subjects with adequate glycemic control while receiving insulin glargine [GI] and completing at least 3 months of therapy with insulin detemir [DI] are included in this report. Ten subjects with Type 2 DM, duration 7 ± 2 years with age, 55 ± 3 years who were switched from GI to DI (Group 1) fulfilled the criteria for inclusion. Subjects were switched from GI in Q AM to DI Q HS in the same daily dose. Glycemic control (HbA1c), body weight, daily insulin dose (Units) and severe hypoglycemic events during the last 2 weeks of the period, pre switch and again at the end of 3 months post switch were assessed. Records of 8 subjects matched for age, duration of DM, glycemic control while receiving GI for additional 3 months (Group 2) during the same period were examined for comparison. All subjects were followed in the outpatient clinic at intervals of 3 months. Results Glycemic control remained stable on continuing GI AM;HbA1c;7.1 ± 0.3 to 7.1 ± 0.3%, while it worsened on switching to DI Q HS;HbA1c, 7.1 ± 0.3 to 8.1 ± 0.5 [P < 0.01]. A mild weight loss was noted in subjects on transition. No severe hypoglycemic events were reported in any subject in either group. Conclusion Abrupt transition from insulin glargine to insulin detemir in subjects with Type 2 DM is likely to result in lapse of glycemic control which may cause decreased quality of life. Furthermore, use of insulin detemir may result in increased costs due to need of the higher daily dose as well as additional equipment required for probable twice daily administration to achieve adequate glycemic control. Therefore, insulin glargine and detemir appear to be far from being bioequivalent.展开更多
目的:探讨参芪降糖胶囊联合地特胰岛素治疗初发2型糖尿病伴肥胖症的效果。方法:选取2020年6月—2022年6月在中国人民解放军第九六〇医院接受治疗的100例初发2型糖尿病伴肥胖症患者为研究对象,根据随机分层法分为对照组(n=50)与研究组(n=...目的:探讨参芪降糖胶囊联合地特胰岛素治疗初发2型糖尿病伴肥胖症的效果。方法:选取2020年6月—2022年6月在中国人民解放军第九六〇医院接受治疗的100例初发2型糖尿病伴肥胖症患者为研究对象,根据随机分层法分为对照组(n=50)与研究组(n=50)。对照组采用地特胰岛素治疗,研究组在对照组的基础上联合参芪降糖胶囊治疗。比较两组用药前后的血糖水平、胰岛功能指标水平、血脂水平及体重指数(BMI)、血糖达标时间。结果:用药后两组空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)水平明显比用药前低,研究组低于对照组,差异有统计学意义(P<0.05)。用药后两组胰岛素抵抗指数(HOMA-IR)水平均比用药前低,且研究组较对照组更低,两组胰岛素β细胞功能(HOMA-β)、空腹胰岛素(FINS)水平比用药前高,且研究组较对照组更高,差异有统计学意义(P<0.05)。两组用药后甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)水平均较用药前降低,研究组比对照组低,两组高密度脂蛋白胆固醇(HDL-C)水平较用药前上升,研究组比对照组高,差异有统计学意义(P<0.05)。两组用药后BMI均下降,且研究组低于对照组,差异有统计学意义(P<0.05)。研究组血糖达标时间比对照组短,差异有统计学意义(P<0.05)。结论:针对初发2型糖尿病伴肥胖症患者采用参芪降糖胶囊联合地特胰岛素进行治疗,不仅能够有效稳定患者血糖与血脂水平,还能降低体重,改善胰岛功能。展开更多
目的探讨住院2型糖尿病患者经皮下胰岛素泵降糖后给予不同治疗方案日内血糖变异情况。方法选取2型糖尿病患者165例,均给予皮下胰岛素泵强化降糖,血糖达标后给予撤泵,随机分为地特+门冬胰岛素组(对照组)和门冬胰岛素30注射液组(试验组)...目的探讨住院2型糖尿病患者经皮下胰岛素泵降糖后给予不同治疗方案日内血糖变异情况。方法选取2型糖尿病患者165例,均给予皮下胰岛素泵强化降糖,血糖达标后给予撤泵,随机分为地特+门冬胰岛素组(对照组)和门冬胰岛素30注射液组(试验组)。比较2组撤泵当日的血糖变异指标:撤泵当日最小血糖值(minimum blood glucose before removing the subcutaneous pump,bminGlu)、撤泵当日血糖水平的标准差(standard deviation of blood glucose before removing the subcutaneous pump,bSDBG)、撤泵当日餐后血糖波动幅度(postprandial glucoseexcursion before removing the subcutaneous pump,bPPGE)、撤泵当日最大血糖波动幅度(largest amplitudeof glycemic excursions before removing the subcutaneous pump,bLAGE)、撤泵当日胰岛素总量(total insulin before removing the subcutaneous pump,bTins)。比较2组皮下注射胰岛素后第4天的血糖变异指标:皮下注射胰岛素后第4天最小血糖值(minimum blood glucose after removing the subcutaneous pump,aminGlu)、皮下注射胰岛素后第4天血糖水平的标准差(standard deviation of blood glucose after removing the subcutaneous pump,aSDBG)、皮下注射胰岛素后第4天餐后血糖波动幅度(postprandial glucoseexcursion after removing the subcutaneous pump,aPPGE)、皮下注射胰岛素后第4天最大血糖波动幅度(largest amplitudeof glycemic excursions after removing the subcutaneous pump,aLAGE)、皮下注射胰岛素后第4天胰岛素总量(total insulin after removing the subcutaneous pump,aTins)。结果2组患者bminGlu、bSDBG、bPPGE、bLAGE、bTins、aminGlu、aSDBG、aPPGE、aLAGE、aTins差异均无统计学意义(P>0.05)。结论住院2型糖尿病患者使用皮下胰岛素泵强化降糖后更换为门冬胰岛素30注射液2次/d与餐时门冬胰岛素+地特胰岛素注射液均能较好的控制血糖、减少血糖波动。展开更多
文摘Objective:To evaluate the meta-analysis of evaluate the clinical efficacy and safety of insulin deside in improving pregnancy with diabetes,and to conduct a Meta-analysis study on the treatment of pregnancy with diabetes.Methods:Before this study,we comprehensively and systematically searched the major literature websites at home and abroad.From the establishment of the database to January 9,2022,we searched the Chinese and English literature on the randomized controlled trial(RCT)of insulin detemir in the treatment of pregnancy complicated with diabetes.We screened them in strict accordance with the acceptance criteria.The bias risk assessment tool in Cochrane system evaluator manual 5.1.0 was used to evaluate the quality of the selected literature,and the Review Manager 5.4 software was used for meta-analysis.Results:Finally,24 RCTs target literatures were obtained,with a cumulative sample size of 2,362 cases.The results of meta-analysis showed that the reduction range of fasting blood glucose,2 h postprandial blood glucose and glycosylated hemoglobin in patients with insulin detemir combined with routine treatment was greater than that in the control group(P<0.05);compared with conventional treatment,the incidence of premature delivery,macrosomia and cesarean section of the diabetes group were lower than those of the control group(P<0.05).Among them,preterm birth(RR=0.44,95%CI[0.28,0.68],P=0.0002),macrosomia(RR=0.35,95%CI[0.21,0.59],P<0.0001),cesarean section(RR=0.82,95%CI[0.72,0.94],P=0.005),fasting blood glucose(SMD=-1.21,95%CI[-1.54,-0.88],P<0.00001),2 h postprandial blood glucose(SMD=-1.63,95%CI[-1.91,-1.35],P<0.00001),glycosylated hemoglobin(SMD=-2.41,95%CI[-3.12,-1.70],P<0.00001).Conclusion:Routine treatment can improve the clinical effect of pregnancy with diabetes.However,there are low limits on the reference level of this study,so this conclusion has some limitations.
文摘The success of a specific treatment is traditionally judged according to parameters such as HbA1c. However, other, patient-reported outcomes (PRO) of (insulin) therapy, become increasingly more important. The introduction of (basal) insulin-analogues could possibly improve PRO, particularly “quality of life”. Direct comparative studies between once daily insulin glargine and once to twice or twice daily insulin detemir have previously shown differences in insulin dosage, dosing frequency and weight gain. Whether this leads to a difference in quality of life in patients who are transferred from insulin detemir to insulin glargine remains to be determined. To establish the effect of insulin glargine on quality of life and patient satisfaction in patients with DM2 who are in poor metabolic control with a (human) basal insulin, a large prospective, observational study in Dutch daily practice was performed. The results of the patient population switched from NPH-insulin to insulin glargine have been published previously. In this article the results of the group of patients treated with insulin detemir before the observation period are described. The results of this observational study show that changing basal insulin therapy to insulin glargine in patients with DM2 who are in poor glycemic control with insulin detemir leads to a clinically significant improvement of glycemic control as well as emotional wellbeing, despite a small increase in weight. Whether other factors such as decreased dosing frequency play a role remains to be determined by future studies.
文摘Background: Iowa Care (Iowa Medicaid in State of Iowa, USA), switched insulin glargine to detemir in subjects with Diabetes Mellitus (DM) without the knowledge or approval of healthcare providers beginning 8/2006.Impact of this transition in subjects with Type 1 DM is recently reported. Objective: To examine the impact of this transition on various parameters of diabetes management in Type 2 DM. Subjects and Methods: A retrospective review of the records of subjects with Type 2 DM was conducted until 8/2007 in whom the transition had occurred. Only those subjects with adequate glycemic control while receiving insulin glargine [GI] and completing at least 3 months of therapy with insulin detemir [DI] are included in this report. Ten subjects with Type 2 DM, duration 7 ± 2 years with age, 55 ± 3 years who were switched from GI to DI (Group 1) fulfilled the criteria for inclusion. Subjects were switched from GI in Q AM to DI Q HS in the same daily dose. Glycemic control (HbA1c), body weight, daily insulin dose (Units) and severe hypoglycemic events during the last 2 weeks of the period, pre switch and again at the end of 3 months post switch were assessed. Records of 8 subjects matched for age, duration of DM, glycemic control while receiving GI for additional 3 months (Group 2) during the same period were examined for comparison. All subjects were followed in the outpatient clinic at intervals of 3 months. Results Glycemic control remained stable on continuing GI AM;HbA1c;7.1 ± 0.3 to 7.1 ± 0.3%, while it worsened on switching to DI Q HS;HbA1c, 7.1 ± 0.3 to 8.1 ± 0.5 [P < 0.01]. A mild weight loss was noted in subjects on transition. No severe hypoglycemic events were reported in any subject in either group. Conclusion Abrupt transition from insulin glargine to insulin detemir in subjects with Type 2 DM is likely to result in lapse of glycemic control which may cause decreased quality of life. Furthermore, use of insulin detemir may result in increased costs due to need of the higher daily dose as well as additional equipment required for probable twice daily administration to achieve adequate glycemic control. Therefore, insulin glargine and detemir appear to be far from being bioequivalent.
文摘目的:探讨参芪降糖胶囊联合地特胰岛素治疗初发2型糖尿病伴肥胖症的效果。方法:选取2020年6月—2022年6月在中国人民解放军第九六〇医院接受治疗的100例初发2型糖尿病伴肥胖症患者为研究对象,根据随机分层法分为对照组(n=50)与研究组(n=50)。对照组采用地特胰岛素治疗,研究组在对照组的基础上联合参芪降糖胶囊治疗。比较两组用药前后的血糖水平、胰岛功能指标水平、血脂水平及体重指数(BMI)、血糖达标时间。结果:用药后两组空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)水平明显比用药前低,研究组低于对照组,差异有统计学意义(P<0.05)。用药后两组胰岛素抵抗指数(HOMA-IR)水平均比用药前低,且研究组较对照组更低,两组胰岛素β细胞功能(HOMA-β)、空腹胰岛素(FINS)水平比用药前高,且研究组较对照组更高,差异有统计学意义(P<0.05)。两组用药后甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)水平均较用药前降低,研究组比对照组低,两组高密度脂蛋白胆固醇(HDL-C)水平较用药前上升,研究组比对照组高,差异有统计学意义(P<0.05)。两组用药后BMI均下降,且研究组低于对照组,差异有统计学意义(P<0.05)。研究组血糖达标时间比对照组短,差异有统计学意义(P<0.05)。结论:针对初发2型糖尿病伴肥胖症患者采用参芪降糖胶囊联合地特胰岛素进行治疗,不仅能够有效稳定患者血糖与血脂水平,还能降低体重,改善胰岛功能。
文摘目的探讨住院2型糖尿病患者经皮下胰岛素泵降糖后给予不同治疗方案日内血糖变异情况。方法选取2型糖尿病患者165例,均给予皮下胰岛素泵强化降糖,血糖达标后给予撤泵,随机分为地特+门冬胰岛素组(对照组)和门冬胰岛素30注射液组(试验组)。比较2组撤泵当日的血糖变异指标:撤泵当日最小血糖值(minimum blood glucose before removing the subcutaneous pump,bminGlu)、撤泵当日血糖水平的标准差(standard deviation of blood glucose before removing the subcutaneous pump,bSDBG)、撤泵当日餐后血糖波动幅度(postprandial glucoseexcursion before removing the subcutaneous pump,bPPGE)、撤泵当日最大血糖波动幅度(largest amplitudeof glycemic excursions before removing the subcutaneous pump,bLAGE)、撤泵当日胰岛素总量(total insulin before removing the subcutaneous pump,bTins)。比较2组皮下注射胰岛素后第4天的血糖变异指标:皮下注射胰岛素后第4天最小血糖值(minimum blood glucose after removing the subcutaneous pump,aminGlu)、皮下注射胰岛素后第4天血糖水平的标准差(standard deviation of blood glucose after removing the subcutaneous pump,aSDBG)、皮下注射胰岛素后第4天餐后血糖波动幅度(postprandial glucoseexcursion after removing the subcutaneous pump,aPPGE)、皮下注射胰岛素后第4天最大血糖波动幅度(largest amplitudeof glycemic excursions after removing the subcutaneous pump,aLAGE)、皮下注射胰岛素后第4天胰岛素总量(total insulin after removing the subcutaneous pump,aTins)。结果2组患者bminGlu、bSDBG、bPPGE、bLAGE、bTins、aminGlu、aSDBG、aPPGE、aLAGE、aTins差异均无统计学意义(P>0.05)。结论住院2型糖尿病患者使用皮下胰岛素泵强化降糖后更换为门冬胰岛素30注射液2次/d与餐时门冬胰岛素+地特胰岛素注射液均能较好的控制血糖、减少血糖波动。
文摘目的 探讨津力达颗粒联合地特胰岛素治疗妊娠期糖尿病(GDM)的临床效果,以期为临床治疗方式的选择提供参考。方法 将2018年1月至2020年12月我院收治的370例GDM患者根据治疗方法的不同分为联合组(186例,地特胰岛素+津力达颗粒)和对照组(184例,地特胰岛素)。比较两组的血管细胞粘附分子-1(VCAM-1)、晚期氧化蛋白产物(AOPP)、网膜素-1、血糖指标[空腹血糖(FBG)、餐后血糖(PBG)、糖化血红蛋白(HbA1c)]、血脂指标[甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]水平、预后不良事件发生情况及新生儿1 min Agpar评分。结果 治疗后,联合组的VCAM-1、AOPP、网膜素-1水平优于对照组(P<0.05)。治疗后,联合组的FBG、PBG水平及HbA1c低于对照组(P<0.05)。治疗后,联合组的TG、TC、LDL-C水平低于对照组,HDL-C水平高于对照组(P<0.05)。联合组的母体、新生儿预后不良事件总发生率低于对照组,新生儿1 min Agpar评分高于对照组(P<0.05)。结论 津力达颗粒、地特胰岛素可以协同降低GDM患者血糖、血脂水平,改善预后。
