门冬胰岛素30不同注射次数对老年2型糖尿病患者临床疗效的比较

摘要

目的 比较门冬胰岛素30皮下注射 2次/d和3次/d两种治疗方案对老年T2DM患者的临床疗效.方法 选取于上海中冶医院内分泌科住院治疗的老年T2DM患者157例,根据门冬胰岛素30皮下注射次数分为2次/d(Bid)组和3次/d(Tid)组.2周后出院,继续治疗≥12周,期间行动态血糖监测(CGM).结果 住院治疗2周后,8段血糖值与入院时相同时段比较,均降低(P<0.01).其中,Tid组午餐后2 h平均血糖和晚餐前平均血糖低于Bid组(P<0.05).72 h CGM显示,Tid组血糖波动低于Bid组(P<0.05).治疗12 周后,HbA1c水平与入院时比较,均降低(P<0.01),Tid组降低幅度和达标率高于Bid组(P<0.05).两组住院2周期间每天胰岛素总量(0.65±0.19) U/kg,其中,Bid组(0.54±0.17) U/kg,Tid组(0.71±0.21) U/kg(P<0.01).住院前2 周,共发生低血糖事件38次,未发生重度低血糖事件.其中,Bid组21次,发生频率6.7次/(患者·年);Tid组17 次,发生频率5.9次/(患者·年).低血糖事件中,夜间低血糖16次,其中,Bid组9次,发生频率2.9次/(患者·年);Tid组7次,发生频率2.4次/(患者·年).两组间总低血糖、重度低血糖及夜间低血糖事件发生频率比较,差异无统计学意义(P>0.05).结论 门冬胰岛素30皮下注射3次/d与2次/d比较,血糖控制效果更好,胰岛素用量虽然较大,但并不增加低血糖风险.%Objective To compare the clinical efficacy of 2 times/day and 3 times/day of biphasic insulin aspart 30 in the treatment of type 2 diabetes mellitus in elderly patients.Methods A total of 157 hospitalized elderly patients with T2DM in Endocrinology Department in Shanghai Smelter Hospital were enrolled in this study.All the subject were divided into two groups according to the subcutaneous injection times of insulin aspart 30 times:2 times /day (Bid group) and 3 times/day (Tid group).After treatment for 2 weeks,all of the subjects were discharged.The treatment was continued for at least 12 weeks out of hospital.Continuous Blood glucose monitoring (CGM) was done in all the subjects.Results After 2 weeks of hospitalization,the period of 8 admission glucose values were decreased as compared with baseline in both groups (P<0.01).The average 2 h post prandial plasma glucose (PPG) after lunch and the average plasma glucose before dinner were lower in Tid group than in Bid group (P<0.05).The 72 h CGM results showed that blood glucose fluctuation was less in Tid group than in Bid group (P<0.05).After 12 weeks of treatment,HbA1c level was decreased as compared with baseline in both groups (P<0.01),especially in Tid group,and the target HbA1c achievement rate was higher in Tid group than in Bid group (P<0.05).The total daily insulin dose during 2 weeks' hospitalization was (0.65±0.19) U/kg,and (0.54±0.17) U/kg in Bid group,(0.71±0.21) U/kg in Tid group (P<0.01).Two weeks before hospitalization,there were in total 38 times of hypoglycemia,and no severe hypoglycemia.Among them,21 times of hypoglycemia were in Bid group,with an occurrence frequency of 6.7 times/year;17 times of hypoglycemia were in Tid group,with an occurrence frequency of 5.9 times/year.There were 16 times of nocturnal hypoglycemia.Among them,9 times of hypoglycemia were in Bid group,with an occurrence frequency of 2.9 times/year;7 times of hypoglycemia were in Tid group,with an occurrence frequency of 2.4 times/year.The frequencies of total hypoglycemia,severe hypoglycemia and nocturnal hypoglycemia were not statistically different between the two groups (P>0.05).Conclusion Subcutaneous injection of insulin aspart 30 three times/day was better than two times/day in controlling blood glucose.And although higher insulin dose in three times/day regimen,it did not increase the risk of hypoglycemia.