不同胰岛素短期强化治疗方案对初发2型糖尿病患者疗效比较  

Comparison of short-term intensive insulin therapy for newly diagnosed type 2 diabetes mellitus

作　　者：梅彩霞 毛英杰 蒋艳诊 MEI Caixia;MAO Yingjie;JIANG Yanzhen(Department of Endocrinopathology,the Second Division of Xinjiang Production and Construction Corps,Korla Hospital,Xinjiang,Korla,841000,China)

机构地区：[1]新疆生产建设兵团第二师库尔勒医院内分泌肾病科

出　　处：《新疆医学》2019年第7期694-697,共4页Xinjiang Medical Journal

摘　　要：目的比较不同胰岛素短期强化治疗方案对初发2型糖尿病患者血糖控制及胰岛β细胞功能影响的差异。方法采用分组对照比较,选取本院初发2型糖尿病患者136例,根据三种短期强化治疗方案将患者随机分为三组,其中A组(49例)为胰岛素泵持续皮下注射的患者,B组(43例)为诺和锐R三餐前皮下注射+甘精胰岛素睡前皮下注射的患者,C组(44例)为预混胰岛素类似物(诺和锐30)早中晚餐前三次皮下注射患者,组间比较降糖效果、对胰岛β细胞功能的影响、费用以及低血糖发生率。结果血糖方面比较A组空腹血糖(FPG)馒头餐后2小时血糖(2hPG)最低:(5.17±0.23)mmoL/L、(6.57±0.68)mmoL/L;胰岛功能方面,A组空腹胰岛素(FIns)、馒头餐后2小时胰岛素(2hFIn s)、胰岛素抵抗指数(HOMA-IR)、胰岛功能指数(HOMA-IS)最高,依次为(9.39±4.36)mU/L、(29.79±18.37)mU/L、(2.15±0.99)、(115.17±56.16);A组治疗达标时胰岛素日剂量、达标时所用时间、达标时胰岛素使用总剂量、达标过程中低血糖发生率均最低,分别为(38.53±6.72)U、(50.55±11.49)h、(80.61±21.90)U、6.12%,C组治疗达标时费用最低(111.25±6.60)元,上述指标组间比较差异具有统计学意义(P<0.05)。结论胰岛素泵治疗初发2型糖尿病患者效果最佳,但费用高;预混胰岛素类似物三次皮下注射费用低,但易发生低血糖,治疗过程中需严密监测血糖水平;三次短效+睡前一次长效胰岛素皮下注射疗效及费用相比其他两种均居中。Objective To compare the effects of different short-term intensive insulin regimens on blood glucose control and islet beta cell function in patients with newly diagnosed type 2 diabetes mellitus.Methods 136 cases of patients with newly diagnosed type 2 diabetes mellitus in our hospital were randomly divided into three groups according to three short-term intensive treatment schemes,the group comparison was used.Patients of the group A(49 cases)were receiving continuous subcutaneous injection with insulin pump,patients of the group B(43 cases)were receiving subcutaneous injection of insulin before meals+insulin glargine before sleep,and patients of the group C(44 cases)were receiving three subcutaneous injections of premix insulin analogues,which did before breakfast,lunch and dinner.Hypoglycemic effects,effects on beta cell function,cost,and incidence of hypoglycemia between groups were compared.Results Compared with the group A,fasting blood glucose(FPG)and 2-hour postprandial blood glucose(2hPG)of steamed bread were the lowest in the group A:(5.17(+0.23)mmoL/L,(6.57(+0.68)mmoL/L);in islet function,the group A had fasting insulin(FIns),2-hour postprandial insulin(2hFIns),insulin resistance index(HOMA-IR),and islet function index(HO).MA-IS was the highest,followed by(9.39(+4.36)mU/L,(29.79(+18.37)mU/L,(2.15(+0.99),(115.17(+56.16).The daily dose of insulin,the time taken to reach the standard,the total dose of insulin used at the time of reaching the standard and the incidence of hypoglycemia in the process of reaching the standard were the lowest in the group A,respectively(38.53+6.72)U,(50.72)U.The treatment cost of the group C was the lowest(111.25 6.60)yuan,and there was a significant difference between the above indexes groups(P<0.05).Conclusion Insulin pump has the best effect in the treatment of newly diagnosed type 2 diabetes mellitus,but the cost is high.Premixed insulin analogues have low cost of three subcutaneous injections,but are prone to hypoglycemia.It is necessary to closely monitor the blood sug

关 键 词：T2DM 血糖 胰岛素 胰岛Β细胞功能 

分 类 号：R587.1[医药卫生—内分泌]