无针注射甘精胰岛素对血糖控制不佳的2型糖尿病患者血糖波动的影响  

Effect of needle-free jet injection of insulin glargine on glycaemic fluctuation in type 2 diabetic patients with uncontrolled glycemia

作　　者：吴霞 严仍娜 蔡玲[1] 李惠琴[1] 马建华[1] 孔小岑[1] Wu Xia;Yan Rengna;Cai Ling;Li Huiqin;Ma Jianhua;Kong Xiaocen(Department of Endocrinology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210012,China)

机构地区：[1]南京医科大学附属南京医院内分泌科,南京210012

出　　处：《中华内分泌代谢杂志》2023年第5期415-420,共6页Chinese Journal of Endocrinology and Metabolism

基　　金：国家重点研发计划(2018YFC1314103)。

摘　　要：目的通过瞬感动态血糖监测,探讨无针注射器和胰岛素笔注射甘精胰岛素对血糖控制不佳的2型糖尿病(T2DM)患者血糖波动的影响。方法采用随机、对照、自身前后交叉的研究设计,共纳入40例腹部皮下注射甘精胰岛素且血糖控制不佳的T2DM患者。随机分为A组(先无针后胰岛素笔,n=20)和B组(先胰岛素笔后无针,n=20)。收集患者临床资料,专科护士对受试者进行注射技术教育,通过使用医院版瞬感血糖监测(FGM)评估患者血糖谱的变化。结果入组患者的空腹血糖(FBG)(9.37±1.84)mmol/L。与传统的胰岛素笔相比,无针注射器注射甘精胰岛素显著降低了24 h平均血糖(MBG)[(9.06±2.13对9.98±2.67)mmol/L,P=0.001]、最高血糖(MaxBG)[(16.69±3.01对17.95±3.48)mmol/L,P=0.001]、血糖>10 mmol/L曲线下面积(AUC)[95.93(21.12,129.02)对142.66(27.88,198.46),P=0.002]、高血糖时间(TAR)(31.10±21.89对39.49±25.93,P=0.003),降低患者MAGE和SDBG,同时显著升高了血糖在目标范围内时间(TIR)(65.94±20.47对58.32±25.00,P=0.001)。两组之间低血糖的风险没有差异。结论空腹血糖控制不佳的T2DM患者使用无针注射器注射甘精胰岛素可有效降低患者的血糖和血糖波动幅度,同时不增加患者发生低血糖的风险。Objective To investigate the effects of insulin glargine administration by jet injection versus conventional insulin pen on glucose profile using professional mode flash glucose monitoring(FGM)system in type 2 diabetic patients with poor glucose control.Methods In this randomized,controlled,crossover study,40 patients with T2DM who treated with insulin glargine were enrolled.The patients were randomly divided into group A(jet injector-conventional pen,n=20)and group B(conventional pen-jet injector,n=20).Each patient wore FreeStyle Libre sensor from day 4 to day 17.The specialist nurse instructed patients how to master the injection techniques.Professional FGM system was applied to assess glucose profile.Results The fasting blood glucose(FBG)of the enrolled patients was(9.37±1.84)mmol/L.In contrast to conventional insulin pen,treatment with the jet injector significantly decreased the 24h MBG[(9.06±2.13 vs 9.98±2.67)mmol/L,P=0.001],MaxBG[(16.69±3.01 vs 17.95±3.48)mmol/L,P=0.001],AUC>10 mmol/L[95.93(21.12,129.02)vs 142.66(27.88,198.46),P=0.002],TAR(31.10±21.89 vs 39.49±25.93,P=0.003),MAGE and SDBG.It was observed that patients using jet injector had significant increased TIR(65.94±20.47 vs 58.32±25.00,P=0.001).There were no difference in the risk of hypoglycaemia between two groups.Conclusion Insulin jet injector was more effective than the insulin pen on glycaemic control and glucose fluctuation without increasing the risk of hypoglycemia in type 2 diabetic patients with uncontrolled glycemia.

关 键 词：糖尿病 2型 无针注射器 胰岛素笔 甘精胰岛素 血糖波动 

分 类 号：R587.1[医药卫生—内分泌]