适合中国2型糖尿病患者的每日2次预混胰岛素剂量分配方案研究  

Premixed insulin twice daily dosing regimen for Chinese people with type 2 diabetes mellitus

作　　者：黄宇新 蒋翠萍 陶晓明 孙皎 HUANG Yuxin;JIANG Cuiping;TAO Xiaoming(Department of Endocrinology,Huadong Hospital Affiliated to Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华东医院内分泌科,上海200040

出　　处：《中国糖尿病杂志》2024年第12期907-911,共5页Chinese Journal of Diabetes

基　　金：国家自然科学基金青年项目(82000778)。

摘　　要：目的探讨适合中国T2DM患者2次/d预混胰岛素分配方案。方法选取2017年3月至2021年10月于复旦大学附属华东医院内分泌科治疗的T2DM患者361例,均接受稳定剂量的2次/d预混合胰岛素且Hb A1c<7%,经连续血糖监测证实葡萄糖目标范围内时间(TIR)>70%,葡萄糖低于目标范围时间(TBR)<1%。根据Ins剂型不同分为Regular/NPH 30组(n=161)、Aspart 30组(n=156)和Lispro 25组(n=44),比较各组生化指标、使用Ins日剂量、早晚餐前Ins剂量及其比值,Pearson相关分析Ins日剂量与其他指标的相关性,多元线性回归分析Ins日剂量的影响因素。结果所有患者Ins平均日剂量(30.6±8.6)U,早餐前Ins平均剂量(18.3±5.1)U,晚餐前Ins平均剂量(12.3±4.2)U,每公斤体重Ins剂量中位数及四分位间距为0.4(0.4,0.5)U/kg·d,早晚餐前Ins比值中位数及四分位间距为1.5(1.3,1.8)。Pearson相关分析显示,Ins日剂量与BMI、FPG、Hb A1c和ALT呈正相关(P<0.05)。多元线性回归分析显示,BMI、FPG、Hb A1c和ALT是Ins日剂量的影响因素。结论中国T2DM患者预混合胰岛素的初始剂量可在早晚餐前以3∶2的比例分配,而非通常推荐的1∶1。Objective To explore the optimal dose of twice daily premixed insulin regimen in Chinese patients with type 2 diabetes mellitus(T2DM).Methods A total of 361 T2DM patients admitted to the department of endocrinology in Huadong hospital affiliated to Fudan university from March 2017 to October 2021 were selected.All patients received stable doses of premixed insulin twice daily and had Hb A1c<7%.Continuous blood glucose monitoring confirmed that TIR was>70%and TBR was<1%.According to different insulin formulations,it was divided into Regular/NPH 30 group(n=161),Aspart 30 group(n=156),and Lispro 25 group(n=44).Clinical characteristics,total insulin dose,pre-breakfast insulin dose,pre-dinner insulin dose,and pre-breakfast/pre-dinner insulin ratio were compared.Pearson correlation analysis was used to analyze the correlation between total insulin dose and other indicators.Multiple linear regression analysis was used to analyze the influencing factors of the total insulin dose.Results The mean dose of total insulin,pre-breakfast insulin,and pre-dinner insulin was(30.6±8.6)U/d,(18.3±5.1)U/d,and(12.3±4.2)U/d,respectively.The median of insulin dose per kg was 0.4(0.4,0.5)U/d,and pre-breakfast/pre-dinner insulin ratio was 1.5(1.3,1.8).Pearson correlation analysis showed that total insulin dose was associated with BMI,Hb A1c,FPG,and ALT.Multiple linear regression analysis showed that BMI,FPG,Hb A1c,and ALT were independent factors of total insulin dose.Conclusions The initial dose of premixed insulin can be allocated at a ratio of 3∶2before breakfast and before dinner in Chinese people with T2DM,not 1∶1.

关 键 词：糖尿病 2型 预混胰岛素 连续血糖监测 

分 类 号：R587.1[医药卫生—内分泌]