CAJ | 학술논문

目的：探讨2型糖尿病患者胰岛素泵基础-餐前剂量配比，并分析影响胰岛素用量的相关因素。方法回顾总结2009年12月至2012年10月于中山大学附属第三医院内分泌与代谢病专科接受短期胰岛素泵治疗的296例住院2型糖尿病患者血糖达标时胰岛素基础-餐前剂量配比情况，并按不同体质指数、糖化血红蛋白水平、腰围等分组分析基础量比例的差异及探讨其相关影响因素。结果患者胰岛素用量为（0.80±0.27）U/kg，基础-餐前剂量配比约为40％∶60％。中心性肥胖患者所需基础量占比例高于非中心性肥胖者（P＜0.05）。Spearman相关分析示基础量比例和病程、腰围及餐后2h肽与空腹C肽比值相关（r＝0.169、0.143、-0.107，均P＜0.05）；多元线性回归分析发现腰围、病程及餐后2hC肽与空腹C肽比值是基础量比例的独立影响因素（β′＝0.096、0.151、-0.116，均P＜0.05）；腰围、空腹血糖及糖化血红蛋白是每公斤体重胰岛素用量的独立影响因素（β′＝0.157、0.311、0.164，均P＜0.05）。结论中国2型糖尿病患者胰岛素泵强化治疗的基础-餐前剂量配比为40％∶60％，基础量比例与中心性肥胖、治疗前胰岛β细胞功能相关；设定胰岛素总量时需考虑中心性肥胖及上泵前血糖情况。
목적：탐토2형당뇨병환자이도소빙기출-찬전제량배비，병분석영향이도소용량적상관인소。방법회고총결2009년12월지2012년10월우중산대학부속제삼의원내분비여대사병전과접수단기이도소빙치료적296례주원2형당뇨병환자혈당체표시이도소기출-찬전제량배비정황，병안불동체질지수、당화혈홍단백수평、요위등분조분석기출량비례적차이급탐토기상관영향인소。결과환자이도소용량위（0.80±0.27）U/kg，기출-찬전제량배비약위40％∶60％。중심성비반환자소수기출량점비례고우비중심성비반자（P＜0.05）。Spearman상관분석시기출량비례화병정、요위급찬후2h태여공복C태비치상관（r＝0.169、0.143、-0.107，균P＜0.05）；다원선성회귀분석발현요위、병정급찬후2hC태여공복C태비치시기출량비례적독립영향인소（β′＝0.096、0.151、-0.116，균P＜0.05）；요위、공복혈당급당화혈홍단백시매공근체중이도소용량적독립영향인소（β′＝0.157、0.311、0.164，균P＜0.05）。결론중국2형당뇨병환자이도소빙강화치료적기출-찬전제량배비위40％∶60％，기출량비례여중심성비반、치료전이도β세포공능상관；설정이도소총량시수고필중심성비반급상빙전혈당정황。
Objective To explore the insulin requirement profiles and analyze the related factors of type 2 diabetics on insulin pump therapy.Methods A total of 296 patients were admitted to hospital for 1-2 weeks of insulin pump therapy and received a diet of 25 -30 kcal/kg ideal body weight per day.Insulin infusion was adjusted to achieve normoglycemia.It was defined as fasting capillary blood glucose of no more than 7.0 mmol/L and capillary blood glucose at 2 hours after each of three meals of no more than 10.0 mmol/L.After goal-reaching for 3 days, the insulin requirement profiles and related factors were analyzed.Results The average time of achieving normoglycemia was ( 5.1 ±2.9 ) days.The total daily insulin dose per kilogram was ( 0.80 ±0.27 ) U/kg and the ratio of total basal insulin dose to total bolus insulin dose 40%∶60%.Patients with central obesity needed a higher ratio of total basal insulin dose to total daily insulin dose ( P<0.05).Associations existed between the ratio of total basal insulin dose to total daily insulin dose and disease duration , waist circumference and ratio of 2 hour-postprandial C-peptide to fasting C-peptide (r=0.169, 0.143, -0.107, all P<0.05).Multivariate linear regression analyses showed that waist circumference , disease duration and ratio of 2 hour-postprandial C-peptide to fasting C-peptide were independently related with the ratio of total basal insulin dose to total daily insulin dose.Also waist circumference, fasting plasma glucose and hemoglobin A 1c levels were independently associated with total daily insulin dose per kilogram.Conclusion The ratio of total basal insulin dose to total bolus insulin dose is 40%∶60%in Chinese type 2 diabetics with insulin pump therapy.And it is associated with central obesity level and β-cell function.Parameters indicating glycemic control and central obesity should be taken into consideration for total insulin requirements.