阿卡波糖控制不佳的老年2型糖尿病患者联合甘精胰岛素或中效胰岛素对血糖的影响

The Influence to the Blood Glucose of Insulin Glargine and Isophane Protamine Insulin in acarbose-poorly-controlled elderly patients with type 2 diabetes mellitus

中文关键词: 老年人  2型糖尿病  甘精胰岛素  低血糖症

英文关键词: elderly  type 2 diabetes mellitus  glargine insulin  hypoglycemia

中文摘要:

      目的 观察甘精胰岛素与中效胰岛素对阿卡波糖控制不佳的老年2型糖尿病患者血糖的影响.方法 选取2014年11月-2015年10月应用拜糖平单药治疗后血糖控制不佳的老年2型糖尿病患者90例,以临床随机表法分为IPI组45例和GI组45例.2组分别在拜糖平治疗的基础上加用低精蛋白锌胰岛素-诺和灵N(isophane protamine insulin,IPI)或甘精胰岛素(glargine insulin,GI)来得时.待血糖稳定后继续治疗8周,比较治疗前后的血糖波动与低血糖的发生情况.结果 治疗8周后2组的空腹血糖(fasting plasma glucose,FPG)、餐后2h血糖(2 h postprandial glucose,2hPG)、糖化血红蛋白Alc (hemoglobin,HbAlc)均低于治疗前,且GI组的基础胰岛素用量少于IPI组[(0.14士0.08)IU/ (kg·d) vs (0.26±0.11) IU/ (kg·d),P＜0.01].与治疗前相比,2组的血糖波动系数V均有所降低,且动态血糖监测发现GI组的血糖波动系数V低于IPI组[(0.96±0.36) vs (2.36±0.27),P＜0.01].2组的24h平均血糖水平(meanlevel of blood glucose,MBG)、高血糖时间比均较治疗前有所减少.GI组24 hMBG低于IPI组[(6.82±1.35)VS (8.88 ±2.01),P＜0.05],高血糖时间比亦少于IPI组.GI组的低血糖(≤3.9mmol/L)时间比与治疗前无统计学差异,而IPI组低血糖(≤3.9mmol/L)时间比多于治疗前[(0.40±0.13) vs (0.16±0.1),P＜0.05].结论 甘精胰岛素较中效胰岛素,与拜糖平联合治疗具有改善患者血糖波动、降低空腹和餐后血糖的作用.

英文摘要:

      Objective To observe the effect of insulin glargine and isophane protamine insulin application on blood glucose in elderly patients with type 2 diabetes mellitus.Method 90 poorly controlled type 2 diabetes mellitus patients were selected during November 2014 to October 2015 of acarbose monotherapy in our hospital geriatrics clinic.The 90 patients were randomly divided into IPI group and GI group which were treated by recombinant intermediate-acting human insulin (isophane protamine insulin,IPI) or long-acting insulin analogues (glargine insulin,GI) respectively on the basis of treatment with Acarbose.The blood glucose fluctuation and the occurrence of hypoglycemia were compared before and after 8 weeks' treatment.Results The FPG,2 hPG,HbA1c after 8 weeks treatment in two groups were significantly lower than that before treatment,but the basal insulin dose of GI group was significantly less than that of IPI group [(0.14±0.08) IU/kg·d vs (0.26 ±0.11) IU/kg· d,P ＜ 0.01].The blood glucose fluctuation coefficient V of GI group was significantly lower than that of IPI group [(0.96±0.36) vs (2.36±0.27),P＜0.01].The 24 hMBG of GI group was lower than that of IPI group [(6.82 ± 1.35) vs (8.88 ±2.01),P＜ 0.05].High blood glucose (＞ 7.8mmol/L or ＞ 11.1mmol) time ratio of GI group was lower than that of IPI group.The time ratio of hypoglycemia (≤3.9 mmol/L) of GI group was less than that of NPH group.Compared the data in two groups before insulin therapy,it was found that:The blood glucose fluctuation coefficient V of two groups both decreased.The 24h MBG and the high blood glucose (＞ 7.8 mmol/L or ＞ 11.1 mmol) time ratio of two groups also significantly decreased.The hypoglycemia (≤ 3.9 mmol/L) time ratio of GI groups had no significant difference after treatment while in IPI group it was significantly more than that before treatment [(0.40 ±0.13) vs (0.16 ±0.1),P ＜ 0.05].Conclusion Compared with IPI and glucosidase inhibitor (acarbose) combination therapy,insulin glargine (Lantus) and glucosidase inhibitor (acarbose) combination therapy could improve the blood glucose fluctuation,decrease fasting and postprandial blood glucose.