摘要
目的 比较地特胰岛素与预混胰岛素在口服降糖药继发性失效的老年T2DM患者起始胰岛素治疗中,对血糖水平及血糖波动的影响. 方法 160例口服降糖药血糖控制不佳的老年T2DM患者,随机分为地特胰岛素联合阿卡波糖治疗（A）组与诺和锐30治疗（B）组,每组各80例.治疗前后采用动态血糖监测系统（CGMS）进行72 h血糖监测,观察平均血糖（MGB）、日内血糖最高值及最低值、最大血糖波动幅度（LAGE）、血糖4.1～11.1 mmol/L时间占日内时间百分比（GTT％）. 结果 （1）2组治疗3个月后,FPG、2hPG和HbA1c水平均降低（P＜0.05或P＜0.01）,2组间FPG、2 hPG和HbA1c水平差异无统计学意义（P＞0.05）,但A组BMI低于B组（P＜0.05）；（2） CGMS监测结果显示,治疗后A组日内血糖最高值、LAGE低于B组[（9.8±2.0） vs （12.5±2.4） mmol/L；（5.2±1.2） vs （8.7±1.8）mmol/L,P＜0.01],日内血糖最低值高于B组[（4.4±0.5）vs（4.0±0.7） mmol/L,P＜0.05].A组GTT％高于B组[（86.6±5.4）％vs（75.1±7.3）％,P＜0.01]；（3）A组低血糖事件发生率低于B组（7.80％vs21.79％,P＜0.05）,2组不良反应发生率差异无统计学意义（P＞0.05）. 结论 相对于预混胰岛素,地特胰岛素作为起始胰岛素联合阿卡波糖,治疗老年T2DM患者更安全、有效,血糖波动更小,低血糖事件发生率更低,且无明显体重增加.
Objective To compare the effect between insulin determir and premixed insulin in elderly T2DM patients who have secondary failure of oral agents about glucose excursion and glucose levels.Methods A total of 160 cases was randomly divided into two groups：insulin determir combined with acarbose （group A） and insulin aspart 30 （group B）,with 80 cases in each group.Before and after 3 month＇s treatment,72 h glycemia monitoring were performed by the continuous glucose monitoring system （CGMS）.The average glycemia levels,intraday highest and lowest glycemia,amplitude peak of glycemia excursion （LAGE）,the percentage of glycemia excursion between 4.1～11.1 mmol/L were recorded for the intraday time （GTT％）.Results （1） FPG、2 hPG and HbA1c were all decreased in two groups after 3 month＇s treatment （P＜0.01）.There was no significant difference between two groups.Meanwhile,body mass index of group A was significantly lower than that of group B （P＜0.05） ; （2） After teratment,the CGMS results indicated that the highest glycemia and LAGE in group A was lower than in group B [（9.8±2.0） vs （12.5±2.4）mmol/L,（5.2±1.2） vs（8.7±1.8） mmol/L,P＜0.01].The intraday lowest glycemia in group A was higher than in group B [（4.4±0.5） vs （4.0±0.7）mmol/L,P＜0.05].And the percentage of glycemia drift between 4.1～11.1 mmol/L accounted for the intraday time was significantly higher than that in group B （P＜0.01） ; （3） The rate of hypoglycemic events in group A was significantly lower than in group B （7.80％ vs 21.79％,P＜0.05）.There was no significant difference in the incidence of adverse reaction between two groups （P＞0.05）.Conclusion As compared with premixed insulin,insulin detemir is more safety,simple and effective for elderly type 2 diabetic patients as initiating insulin therapy,showing smaller glycemic variability,lower incidence of hypoglycemia and less weight gain.
出处
《中国糖尿病杂志》
CAS
CSCD
北大核心
2013年第11期1021-1024,共4页
Chinese Journal of Diabetes
关键词
糖尿病
2型
老年
地特胰岛素
预混胰岛素
动态血糖监测
血糖波动
Diabetes mellitus, type 2, elderly
Insulin determir
Premixed insulin
Continuous glucose monitoring system
Glycemia variability
