2型糖尿病患者胰岛素泵基础-餐前剂量配比及其影响因素探讨  

Insulin requirement profiles and related factors of type 2 diabetics with insulin pump therapy

作　　者：张秀珍[1] 姚麟[2] 邓洪容[1] 严晋华[1] 朱延华[1] 许雯[1] 姚斌[1] 翁建平[1] 

机构地区：[1]中山大学附属第三医院内分泌与代谢病学科广东省糖尿病防治重点实验室,广州510630 [2]中山大学附属第三医院医务科,广州510630

出　　处：《中华医学杂志》2014年第31期2417-2421,共5页National Medical Journal of China

基　　金：教育部博士点基金-新教师类（20100171120086）

摘　　要：目的：探讨2型糖尿病患者胰岛素泵基础-餐前剂量配比，并分析影响胰岛素用量的相关因素。方法回顾总结2009年12月至2012年10月于中山大学附属第三医院内分泌与代谢病专科接受短期胰岛素泵治疗的296例住院2型糖尿病患者血糖达标时胰岛素基础-餐前剂量配比情况，并按不同体质指数、糖化血红蛋白水平、腰围等分组分析基础量比例的差异及探讨其相关影响因素。结果患者胰岛素用量为（0.80±0.27）U/kg，基础-餐前剂量配比约为40％∶60％。中心性肥胖患者所需基础量占比例高于非中心性肥胖者（P＜0.05）。Spearman相关分析示基础量比例和病程、腰围及餐后2h肽与空腹C肽比值相关（r＝0.169、0.143、-0.107，均P＜0.05）；多元线性回归分析发现腰围、病程及餐后2hC肽与空腹C肽比值是基础量比例的独立影响因素（β′＝0.096、0.151、-0.116，均P＜0.05）；腰围、空腹血糖及糖化血红蛋白是每公斤体重胰岛素用量的独立影响因素（β′＝0.157、0.311、0.164，均P＜0.05）。结论中国2型糖尿病患者胰岛素泵强化治疗的基础-餐前剂量配比为40％∶60％，基础量比例与中心性肥胖、治疗前胰岛β细胞功能相关；设定胰岛素总量时需考虑中心性肥胖及上泵前血糖情况。Objective To explore the insulin requirement profiles and analyze the related factors of type 2 diabetics on insulin pump therapy.Methods A total of 296 patients were admitted to hospital for 1-2 weeks of insulin pump therapy and received a diet of 25 -30 kcal/kg ideal body weight per day.Insulin infusion was adjusted to achieve normoglycemia.It was defined as fasting capillary blood glucose of no more than 7.0 mmol/L and capillary blood glucose at 2 hours after each of three meals of no more than 10.0 mmol/L.After goal-reaching for 3 days, the insulin requirement profiles and related factors were analyzed.Results The average time of achieving normoglycemia was （ 5.1 ±2.9 ） days.The total daily insulin dose per kilogram was （ 0.80 ±0.27 ） U/kg and the ratio of total basal insulin dose to total bolus insulin dose 40%∶60%.Patients with central obesity needed a higher ratio of total basal insulin dose to total daily insulin dose （ P〈0.05）.Associations existed between the ratio of total basal insulin dose to total daily insulin dose and disease duration , waist circumference and ratio of 2 hour-postprandial C-peptide to fasting C-peptide （r=0.169, 0.143, -0.107, all P〈0.05）.Multivariate linear regression analyses showed that waist circumference , disease duration and ratio of 2 hour-postprandial C-peptide to fasting C-peptide were independently related with the ratio of total basal insulin dose to total daily insulin dose.Also waist circumference, fasting plasma glucose and hemoglobin A 1c levels were independently associated with total daily insulin dose per kilogram.Conclusion The ratio of total basal insulin dose to total bolus insulin dose is 40%∶60%in Chinese type 2 diabetics with insulin pump therapy.And it is associated with central obesity level and β-cell function.Parameters indicating glycemic control and central obesity should be taken into consideration for total insulin requirements.

关 键 词：胰岛素泵 2型糖尿病 基础量 餐前大剂量 

分 类 号：R587.1[医药卫生—内分泌]