使用动态血糖监测比较地特胰岛素与甘精胰岛素联合门冬胰岛素强化控糖后2型糖尿病患者的血糖波动情况的观察

摘要

Objective To compare blood glucose fluctuation and glucose-lowering efficacy in patients with type 2 diabetes between insulin detemir versus insulin glargine combined with insulin aspart by using continuous glucose monitoring system (CGMS). Methods Sixty T2DM patients previously treated with oral antihyperglycemic drugs with poor glycemic control first received continuous subcutaneous insulin infusion (CSⅡ) therapy. After their blood glucose reached the goal (FPG<7. 0 mmol/L, 2 hPG<10. 0 mmol/L), they were randomized into two groups: insulin aspart before each meal combined with insulin detemir(Asp+Det group) versus insulin glargine(Asp+Gla group) at bedtime. The glucose levels were monitored with CGMS, when fasting plasma glucose achieved the target (5. 6 mmol/L) obtaining the third 24 h mean blood glucose (MBG). The largest amplitude of glycemic excursions (LAGE), the mean amplitude of glycemic excursions (MAGE) within one day, and the number of days when reaching the standard, the insulin doses needed to reach the goal, as well as the incidence of hypoglycemia events were recorded. Results After the FPG reached the goal, there were significant differences in the time, basal and total insulin dosage used between the two groups (P>0. 05). At third 24 h measurement, the MBG, LAGE and MAGE recorded by CGMS and the blood glucose fluctuation were similar in the two groups (P>0. 05). The incidence of hypoglycemia was 3% in the Gla+Asp group and 2. 0% in the Det+Asp group (P>0.05). Conclusion Both groups have a good control of blood glucose. After the FPG reaches the goal, a similar effect on blood glucose fluctuation of the two groups is achieved (P>0. 05), and there is no significant difference between them in the incidence of hypoglycemia (P>0. 05).%目的 使用动态血糖监测系统(CGMS)比较地特胰岛素与甘精胰岛素联合门冬胰岛素强化控糖后T2DM患者全天血糖波动情况. 方法 60例使用口服降糖药物治疗血糖控制不佳的T2DM患者,入院后先进行胰岛素泵强化控糖治疗,患者血糖达到目标值后(FPG＜7.0 mmol/L,2hPG＜10.0mmol/L)按1∶1的比例随机分为两组,一组用三餐前门冬胰岛素联合睡前甘精胰岛素(Asp+Gla组),另一组用三餐前门冬胰岛素联合睡前地特胰岛素(Asp+Det组)继续强化控制血糖,在患者FPG达标后(5.6 mmol/L)行72 h CGMS,获取患者第3个24 h内平均血糖(MBG)、最大血糖波动幅度(LAGE)、一日内平均血糖波动幅度(MAGE)、以及患者达标时的治疗天数,比较达标时Gla及Det使用剂量以及低血糖等不良事件的发生率. 结果 FPG达标后,两组在血糖达标的时间、达标时基础胰岛素用量、总胰岛素用量方面,差异无统计学意义(P＞0.05).CGMS记录的第3个24 h内MBG、LAGE及MAGE,两组血糖波动情况差异无统计学意义(P＞0.05).低血糖发生率Asp+ Gla组为3.0％,Asp+Det组为2.0％,两组比较差异无统计学意义(P＞0.05). 结论 两组治疗方案均可较好地控制血糖,FPG达标后,两组全天血糖波动情况与低血糖事件的发生率差异均无统计学意义(P＞0.05).