不同胰岛素皮下注射方案T2DM患者的血糖变异性比较

Comparison of blood glucose variability of different insulin injection programs after intensive therapy using a insulin pump in patients with type 2 diabetes

摘要:

比较胰岛素泵治疗血糖达标的2 型糖尿病（T2DM）患者改用不同胰岛素皮下注射方案后的血糖变异性。方法选取住院T2DM 患者360 例，均给予胰岛素泵控制血糖，待血糖控制达标后，随机分为门冬胰岛素联合地特胰岛素（Asp+Det）组、门冬胰岛素30（Asp30组、诺和灵50R（Nov50R）组，每组各120 例。记录患者出院时的一般资料和生化指标，治疗3 个月后来院复查血糖及相关指标，并采用72 h 动态血糖监测系统，获取患者第3 个24 h 内平均血糖（MBG）、最大血糖波动幅度（LAGE）、1 d 内平均血糖波动幅度（MAGE）、血糖变异系数（CV）及空腹血糖变异系数（CV-FPG）。结果①各组3 个月后体重指数、餐后2 h 血糖（2 hPG）及糖化血红蛋白（HbA1c）比较，差异无统计学意义（p >0.05）。Nov50R 组空腹血糖、胰岛素总用量及低血糖发生率均高于Asp+Det组和Asp30组，Asp+Det组和Asp30组比较，差异无统计学意义（p >0.05）；②各组24 hMBG比较，差异无统计学意义（p >0.05）。Nov50R 组和Asp30 组LAGE、MAGE、CV 及CV-FPG 高于Asp+Det 组，Nov50R 组LAGE、CV 及CV-FPG 高于Asp30 组。结论糖尿病患者胰岛素泵治疗血糖达标后改用Asp+Det治疗较单用Asp30 或Nov50R 血糖控制更平稳，且胰岛素用量和低血糖发生率更低。

Abstract:

To compare the blood glucose variability of different subcutaneous insulin injection programs after intensive therapy using a insulin pump in patients with type 2 diabetes (T2DM). Methods A total of 360 T2DM patients were treated with insulin pump and then converted to use insulin aspart with insulin detemir (Asp+Det group), insulin aspart 30 (Asp30 group) and Novolin 50R (Nov50R group), each group had 120 cases. The general data and biochemical indexes were recorded at discharge. Blood glucose and other related indexes were tested after 3 months of treatment. The third 24-h mean blood glucose (MBG),the largest amplitude of glycemic excursion (LAGE), the mean amplitude of glycemic excursions (MAGE) within one day, coefficient variation (CV) and CV-FPG were monitored with continuous glucose monitoring system. Results There was no significant difference in BMI, 2-h PG or HbA1c among the three groups (p >0.05). The FPG, the total insulin dosage and the rate of hypoglycemic events in the Nov50R group were higher than those in the Asp+Det group and the Asp30 group (p < 0.05), but there was no significant difference between the Asp+Det and Asp30 groups (p > 0.05). There was no statistical significance in 24-hMBG among the three groups (p > 0.05). The LAGE, MAGE, CV and CV-FPG in the Nov50R and Asp30 groups were higher than those in the Asp+Det group (p < 0.05); and the LAGE, CV and CV-FPG in the Nov50R group were higher than those in the Asp30 group (p < 0.05). Conclusions The blood glucose variability of insulin Asp with insulin Det after intensive therapy using a insulin pump in patients with type 2 diabetes is lower than that of only Asp30 or Nov50R, and the insulin dosage and the rate of hypoglycemic events are lower.