2型糖尿病肥胖患者口服降糖药失效启用胰岛素治疗方案的探讨  

Investigate on the Selection of Insulin Therapy for Obese Patients with Type 2 Diabetes Mellitus after the Failure of Oral Antihyperglycemic Drugs

作　　者：陈玉华[1] 陈敏[1] 邱平[1] 王艳[1] 赵雨[1] 李玲[1] 严宗逊[1] 

机构地区：[1]川北医学院附属医院内分泌科,四川南充637000

出　　处：《华西医学》2011年第11期1636-1638,共3页West China Medical Journal

摘　　要：目的探讨2型糖尿病肥胖患者在口服降糖药继发失效的情况下启用胰岛素治疗方案的选择。方法选择2009年1月2010年12月间40例口服降糖药失效的2型糖尿病肥胖患者,随机分为两组,每组20例。A组原口服药不变,睡前联用长效胰岛素(商品名:来得时)治疗,B组停用口服药,于早晚餐前使用预混胰岛素(商品名:诺和灵30R),治疗共3个月,分别于治疗前后观察空腹血糖、餐后2h血糖、糖化血红蛋白、血脂、血压、体质量指数的变化,记录低血糖发生次数,并填写问卷调查表,评估患者对治疗方案的满意度和接受度。结果两个组治疗后空腹血糖、餐后2h血糖、糖化血红蛋白均较治疗前明显下降(P<0.01),而血脂、血压变化不大;但B组体质量指数有轻微升高(P>0.05),且每日胰岛素用量较A组更大(P<0.01),低血糖反应更多(P<0.05),满意度和接受度不如A组高(P>0.05)。结论对2型糖尿病肥胖患者在口服降糖药继发失效的情况下启用胰岛素治疗,选用口服降糖药联合基础胰岛素的治疗方案具有作用佳、安全性好,体重增加不明显,患者依从性更高的特点。Objective To investigate the selection of insulin therapy for obese patients with type 2 diabetes mellitus（T2DM） after the failure of oral antihyperglycemic drugs.Methods Forty obese T2DM subjects who failed the therapy of oral antihyperglycemic drugs between January 2009 and December 2010 were divided into 2 groups randomly.Patients in group A（n=20） continued using oral antihyperglycemic agents while long-acting insulin（Lantus） was added at bedtime;Patients in group B（n=20） used premixed insulin（Novolin 30R） injection before breakfast and supper instead of the oral drugs.The treatment lasted for 3 months for both groups.Fasting plasma glucose（FPG）,blood glucose 2 hours after breakfast（2hPG）,glycated hemoglobin（HbA1c）,serum lipids,blood pressure,and body mass index（BMI） were examined before and after the trial respectively.We evaluated the satisfaction and acceptance level in all subjects who underwent the treatment with questionnaires.Results FPG,2hPG,HbA1c after the treatment were significantly lower than those before the treatment in both two groups（P0.01）,while serum lipids and blood pressure showed no significant differences.Patients in group B had slightly higher BMI（P0.05） after the treatment.Compared with patients in group A,they needed a larger insulin dosage（P0.01）,had higher hypoglycemia frequency（P0.05） and lower satisfaction and acceptance level（P0.05）.Conclusion For obese patients with T2DM who have failed the therapy of oral antihyperglycemic drugs,combined oral antihyperglycemic drugs with basic insulin has better effects,security,and compliance,and less weight gain.

关 键 词：2型糖尿病 肥胖 胰岛素 治疗 

分 类 号：R587.1[医药卫生—内分泌] R977.15[医药卫生—内科学]