CAJ | 학술논문

目的观察甘精胰岛素注射液联合口服降糖药物瑞格列奈对老年2型糖尿病患者的血糖控制情况和低血糖的风险. 方法选择口服降糖药物血糖控制不良的老年2型糖尿病患者64例,随机分为甘精胰岛素组(简称甘精组)和预混胰岛素组(诺和灵30R,简称预混组),每组各32例.甘精组在每天3餐前口服瑞格列奈的基础上,每晚22时注射甘精胰岛素1次;预混组每天早、晚餐前分别注射诺和灵30R预混胰岛素;根据空腹血糖及餐后血糖的水平,每3天调整瑞格列奈及胰岛素剂量,以空腹血糖<7.2 mmol/L,餐后血糖<10.0 mmol/L为治疗目标,共治疗16周,观察血糖控制和低血糖发生情况. 结果治疗16周后两组的全天血糖谱和糖化血红蛋白(HbAlc)有明显下降(P<0.05),甘精组全天各时点血糖均值低于预混组,其中午餐后、晚餐后2 h血糖与预混组比较,差异有统计学意义(均为P<0.05),甘精组HbAlc值明显低于预混组(P<0.05);体质指数(BMI)甘精组无明显增加(P>0.05),预混组BMI较治疗前明显增加(P<O.05);甘精组低血糖事件明显少于预混组(甘精组2例,6.3%;预混组12例,37.5%;P<0.05). 结论老年2型糖尿病患者在单用口服降糖药不能良好控制血糖时,应用每天1次甘精胰岛素加瑞格列奈口服或改用每天2次预混胰岛素治疗均能达到控制血糖效果,甘精胰岛素降低午餐后、晚餐后血糖及HbAlc的效果更好,低血糖发生率低,体质量未见明显增长.
목적 관찰감정이도소주사액연합구복강당약물서격렬내대노년2형당뇨병환자적혈당공제정황화저혈당적풍험. 방법 선택구복강당약물혈당공제불량적노년2형당뇨병환자64례,수궤분위감정이도소조(간칭감정조)화예혼이도소조(낙화령30R,간칭예혼조),매조각32례.감정조재매천3찬전구복서격렬내적기출상,매만22시주사감정이도소1차;예혼조매천조、만찬전분별주사낙화령30R예혼이도소;근거공복혈당급찬후혈당적수평,매3천조정서격렬내급이도소제량,이공복혈당<7.2 mmol/L,찬후혈당<10.0 mmol/L위치료목표,공치료16주,관찰혈당공제화저혈당발생정황. 결과 치료16주후량조적전천혈당보화당화혈홍단백(HbAlc)유명현하강(P<0.05),감정조전천각시점혈당균치저우예혼조,기중오찬후、만찬후2 h혈당여예혼조비교,차이유통계학의의(균위P<0.05),감정조HbAlc치명현저우예혼조(P<0.05);체질지수(BMI)감정조무명현증가(P>0.05),예혼조BMI교치료전명현증가(P<O.05);감정조저혈당사건명현소우예혼조(감정조2례,6.3%;예혼조12례,37.5%;P<0.05). 결론 노년2형당뇨병환자재단용구복강당약불능량호공제혈당시,응용매천1차감정이도소가서격렬내구복혹개용매천2차예혼이도소치료균능체도공제혈당효과,감정이도소강저오찬후、만찬후혈당급HbAlc적효과경호,저혈당발생솔저,체질량미견명현증장.
Objective To compare the blood glucose level and associated hypoglycemia risks between group of insulin glargine combined with repaglinide and group of mixed insulin in the treatment of type 2 diabetes in the elderly. Methods Sixty four type 2 diabetes patients (age≥60 years) with inadequate glyeaemic control by drugs were divided into 2 groups randomly: glargine group (32 cases) and mixed insulin group (32 cases). In glargine group, 32 patients were given repaglinide before breakfast, lunch, supper respectively and injection of glargine hypodermically once at 22 o'clock every night, while the 32 patients in mixed insulin group were injected with the mixed insulin (Novolin 30R) hypodermically before breakfast and supper respectively for 16 weeks. The dose of repaglinide and insulin were adjusted every 3 days according to the level of fasting glucose (FPG)and postprandial glucose (PPG), reaching the aim of FPG less than 7.2 mmol/L and PPG less than 10mmol/L. The blood glucose level and the incidence of hypoglycemia were observed. Results The daily glucose profile and the level of HbAlc of the 2 groups dropped obviously after 16 weeks treatments (all P<0. 05). At the end of the experiment, the PPG of lunch and supper, and the level of HbAlc were markedly lower in glargine group than in mixed insulin group (all P<0. 05), and the body mass index (BMI) increased markedly in mixed insulin group compared with pre-experiment (P<0. 05), but no significant change was found in glargine group (P>0. 05). The incidence of hypoglycemia in glargine group was lower than that in mixed insulin group (2 patients in glargine group, 12 patients in mixed insulin group, P<0.05). Conclusions Both of the mixed insulin and glargine combined with repaglinide have visible effects on controlling the blood glucose, but the latter has better efficacy, lower risk of hypoglycemia and lower increase of BMI than the former.