CAJ | 학술논문

目的:观察低精蛋白锌胰岛素(NPH)与预混胰岛素联合口服降糖药在新诊断2型糖尿病中的有效性及安全性.方法:将就诊于天津医科大学代谢病医院门诊新诊断的空腹血糖(FBG)≥12mmol·L-1或糖化血红蛋白(HbA1C)≥9.5%的128例2型糖尿病(T2DM)患者随机分成两组,每组64例,分别给予NPH联合瑞格列奈、二甲双胍治疗和预混胰岛素联合阿卡波糖、二甲双胍治疗.治疗12周后,观察两组FBG、餐后血糖(2hPBG)、HbA1C、腰臀围及体重的变化,以及低血糖的情况.结果:治疗12周后,两组FPG、2hPPG、HbA1C均较治疗前下降(P<0.01),但NPH组下降更明显(P<0.01).NPH联合口服药组FBG、2hPBG、HbA1C分别由(14.3±2.1) mmol·L-1、(18.6±3.8) mmol·L-1、(11.5±2.1)%降至(6.3±1.1) mmol·L-1、(8.2±1.7) mmol·L-1、(6.6±1.6)%,均P<0.01;预混胰岛素联合口服药组FBG、2hPBG、HbA1C分别由(14.1±2.1) mmol·L-1、(18.4±3.7) mmol·L-1、(11.3±2.1)%降至(7.1±1.7) mmol·L-1、(9.1±2.0) mmol·L-1、(7.7±1.3)%,均P<0.01.NPH联合口服药组体重由(65.2±11.7)kg增加至(66.1±10.9)kg;预混胰岛素联合口服药组体重由(66.0±11.6)kg增加至(67.8±10.8)kg(P=0.01).NPH用量平均(9±3.6)U·d-1明显少于预混胰岛素(17±3.3)U·d-1(P=0.0001).NPH联合口服药组HbA1C达标率(87.5%)优于预混胰岛素联合口服药组(73.4%),P=0.045.NPH联合口服药组低血糖发生率明显低于预混胰岛素联合口服药组(P=0.042).结论:与预混胰岛素组相比,NPH联合瑞格列奈和二甲双胍治疗新诊断血糖较高的2型糖尿病患者疗效更好,胰岛素用量少,对体重的影响小,低血糖风险低.
목적:관찰저정단백자이도소(NPH)여예혼이도소연합구복강당약재신진단2형당뇨병중적유효성급안전성.방법:장취진우천진의과대학대사병의원문진신진단적공복혈당(FBG)≥12mmol·L-1혹당화혈홍단백(HbA1C)≥9.5%적128례2형당뇨병(T2DM)환자수궤분성량조,매조64례,분별급여NPH연합서격렬내、이갑쌍고치료화예혼이도소연합아잡파당、이갑쌍고치료.치료12주후,관찰량조FBG、찬후혈당(2hPBG)、HbA1C、요둔위급체중적변화,이급저혈당적정황.결과:치료12주후,량조FPG、2hPPG、HbA1C균교치료전하강(P<0.01),단NPH조하강경명현(P<0.01).NPH연합구복약조FBG、2hPBG、HbA1C분별유(14.3±2.1) mmol·L-1、(18.6±3.8) mmol·L-1、(11.5±2.1)%강지(6.3±1.1) mmol·L-1、(8.2±1.7) mmol·L-1、(6.6±1.6)%,균P<0.01;예혼이도소연합구복약조FBG、2hPBG、HbA1C분별유(14.1±2.1) mmol·L-1、(18.4±3.7) mmol·L-1、(11.3±2.1)%강지(7.1±1.7) mmol·L-1、(9.1±2.0) mmol·L-1、(7.7±1.3)%,균P<0.01.NPH연합구복약조체중유(65.2±11.7)kg증가지(66.1±10.9)kg;예혼이도소연합구복약조체중유(66.0±11.6)kg증가지(67.8±10.8)kg(P=0.01).NPH용량평균(9±3.6)U·d-1명현소우예혼이도소(17±3.3)U·d-1(P=0.0001).NPH연합구복약조HbA1C체표솔(87.5%)우우예혼이도소연합구복약조(73.4%),P=0.045.NPH연합구복약조저혈당발생솔명현저우예혼이도소연합구복약조(P=0.042).결론:여예혼이도소조상비,NPH연합서격렬내화이갑쌍고치료신진단혈당교고적2형당뇨병환자료효경호,이도소용량소,대체중적영향소,저혈당풍험저.
Objective: To observe the efficacy and safety of NPH versus premixed insulin combined with oral antidiabetic drugs in the treatment of newly diagnosed type 2 diabetic patients. Methods: The 128 newly diagnosed type 2 diabetic patients which FBG was at least 12 mmol/L or HbA1C at least 9.5%were randomly assigned to receive insulin NPH and OADs( repaglinide and metformin) or premixed insulin and OADs( acarbose and metformin),respectively ,for 12 weeks. Fasting blood glucose,2-hour past-meal blood glucose,blood hem-atoglobin A1C, waistline,hipline, body weight and the frequency of hypoglycemia were analyzed before and after the treatment . Results:After the 12-week of treatment ,the levels of FBG,2hPBG,and HbA1C of the two groups were decreased(P﹤0.01),while the decrease in the NPH group was more significant(P﹤0.01). the levels of FBG,2hPBG,and HbA1C were al decreased significantly in NPH group than those of baselines ,from (14.3±2.1) mmol/L,(18.6±3.8) mmol/L,(11.5±2.1)%to (6.3±1.1) mmol/L,(8.2±1.7) mmol/L,(6.6±1.6)%, respectively;al P﹤0.01. And those indicator were al significantly declined too in premixed insulin group, from (14.1±2.1) mmol/L,(18.4±3.7) mmol/L,(11.3±2.1)%to (7.1±1.7) mmol/L,(9.1±2.0) mmol/L,(7.7±1.3)%,respectively,and al P﹤0.01. The increase of body weight in NPH group(0.88kg) was inferior to premixed insulin group(1.84kg) (P﹤0.01).The doses of NPH(9±3.6)U/d was significantly lower than these of premixed insulin(17±3.3)U/d (P=0.0001).As HbAIC﹤7.0%for target, targeting of HbA1C in NPH group(87.5%)was superior to the premixed insulin group(73.4%)(P=0.045). The incidence of hypoglycemia in NPH group was inferior to the premixed insulin group(P=0.042). Conclusion: As compared with premixed insulin plus acarbose or metformin,the ef ect of insulin NPH and OADs( repaglinide and metformin) is bet er in newly diagnosed patients with less doses of insulin ,less incidence of hypoglycemia and less influence on body weight.