2型糖尿病胰岛素泵强化治疗后胰岛素剂量谱的分析及应用  

Application of insulin dose spectrum after an intensive insulin pump therapy in type 2 diabetes mellitus

作　　者：杜斯娜 李伟 林雅静 孙建国 毛毛 陈坚伟 孙丹波 毛玉山[7] Du Sina;Li Wei;Lin Yajing;Sun Jianguo;Mao Mao;Chen Jianwei;Sun Danbo;Mao Yushan(Department of Medicine,Ningbo University,Ningbo 315211,China;Department of Endocrinology,Cixi People's Hospital Medical and Healthcare Group(Cixi People's Hospital),Ningbo 315300,China;Department of Endocrinology,Li Huili Hospital,Ningbo Medical Center,Ningbo 315048,China;Department of Endocrinology,the First Hospital of Ninghai County,Ningbo 315699,China;Department of Endocrinology,Ningbo Development Zone Center Hospital,Ningbo 315899,China;Changhe Branch,Cixi Third People's Hospital Medical Health Group,Ningbo 315326,China;Department of Endocrinology,Bund Hospital,The First Affiliated Hospital of Ningbo University,Ningbo 315020,China)

机构地区：[1]宁波大学医学部,浙江宁波315211 [2]慈溪市人民医院医疗健康集团(慈溪市人民医院)内分泌科,浙江宁波315300 [3]宁波市医疗中心李惠利医院内分泌科,浙江宁波315048 [4]宁海县第一医院内分泌科,浙江宁波315699 [5]宁波开发区中心医院内分泌科,浙江宁波315899 [6]慈溪市第三人民医院医疗健康集团长河分院,浙江宁波315326 [7]宁波大学附属第一医院外滩院区内分泌科,浙江宁波315020

出　　处：《临床荟萃》2024年第7期620-624,共5页Clinical Focus

基　　金：宁波市科技服务业示范项目——基于人工智能的糖尿病移动网络教育示范平台的构建研究(2019F1007);宁波市医学科技计划项目——糖尿病夜间低血糖“心率变化预警阈值”的临床研究(2019Y66);温州医科大学2023年度课程思政教学创新改革项目——“医患共情”的人文思政视域下糖尿病患者性功能疾患的课程教学的实践与研究(KCSZJG202332)。

摘　　要：目的探讨2型糖尿病(type 2 diabetesmellius,T2DM)患者预混胰岛素类似物的治疗时间、治疗时机和种类。方法收集中国宁波市5家医院应用CSII短期强化治疗的2型糖尿病患者655例,分析确定最佳预混胰岛素类似物治疗方案。结果CSII滴定后胰岛素用量,餐前胰岛素总量/基础胰岛素总量比值为1.12;胰岛素总量(51.35±29.7)U。晚餐前有58%推荐中预混胰岛素类似物为宜。早餐前74%推荐低预混胰岛素类似物为宜。根据患者个体化巧妙搭配不同剂型预混胰岛素类似物来达到最佳的控制血糖的效果。预混一天两次注射(BID)早晚推断剂量均值比为3∶2。早多晚少的预混胰岛素类似物剂量比值有助于更简易地告知患者胰岛素的剂量,避免早晚剂量的混淆导致低血糖的发生。胰岛素泵强化治疗的结果显示:糖尿病患者的胰岛素剂量谱具有极大的异质性,量化的选择更有意义。结论一天两次注射(BID)预混胰岛素类似物方案:晚餐前推荐中预混为宜,早餐前推荐低预混为宜。临床上大部分患者选用单种胰岛素治疗,医生可根据患者血糖、个体差异,或联合口服降糖药,在两款剂型中选择最佳方案。Objective To explore the treatment time,timing and type of premixed insulin analogs in patients with type 2 diabetes mellitus(T2DM).Methods A total of 655 T2DM patients treated with continuous subcutaneous insulin infusion(CSII)short-term intensive treatment in 5 hospitals in Ningbo City,China were recruited to determine the optimal treatment plan of premixed insulin analogs.Results After CSII titration,the ratio of insulin dosage before meals to total basal insulin was 1.12,with the total insulin dosage of 51.35±29.7 U.58%of T2DM patients were recommended to the use of premixed insulin analogs before dinner.74%of them were recommended to the use of low premixed insulin analogs before breakfast.An individualized preparation of premixed insulin analogs with varied dosage formulations was expected to yield the optimal goal to control blood sugar.An inferred ratio of premixed insulin analogs twice a day(b.i.d.)in the morning and evening was 3∶2.A higher dosage in the morning than evening favored a simple informed consent of insulin dosage,thus preventing the misuse of premixed insulin analog dosages in the morning and evening and the incidence of hypoglycemia.An intensive insulin pump therapy showed that the insulin dose spectrum of T2DM was extremely heterogeneous,and a quantitative selection was of more significance.Conclusion A premixed insulin analog regimen b.i.d.is recommended,with a medium premixing before dinner,and low premixing before breakfast.A single type of insulin is dominant in clinical treatment of T2DM.An optimal regimen of the two types of premixed insulin analogs,either combined with oral hypoglycemic drugs or not,can be selected based on the individualized conditions of blood sugar.

关 键 词：糖尿病 2型 胰岛素泵 胰岛素剂量谱 预混胰岛素 

分 类 号：R587.1[医药卫生—内分泌]