目的 比較每日注射一次長效重組甘精胰島素注射液與中效低糖蛋白鋅人胰島素(NPH)聯(lián)合口服格列吡嗪控釋片治療2型糖尿病的血糖控制情況和低血糖的風(fēng)險.
方法 56例口服降糖藥血糖控制不理想的2型糖尿病患者按3：1隨機(jī)分為甘精胰島素治療組(n=42)和NPH組(n=14).分別采用每日晨起口服格列吡嗪控釋片5 mg,每晚10點注射重組甘精胰島素和每日晨起口服格列吡嗪控釋片5mg,每晚10點注射中效NPH胰島素.根據(jù)空腹血糖(FBG)水平調(diào)整胰島素用量,以兩組FBG均達(dá)到＜6.7 mmol/L為治療目標(biāo),共治療12周,觀察血糖控制和低血糖事件發(fā)生情況,分析FBG達(dá)標(biāo)時所用甘精胰島素日劑量與治療前FBG、BMI和病程的關(guān)系.
結(jié)果 治療后兩組Alc及全天血糖譜均較基線水平明顯下降,兩組下降幅度比較無統(tǒng)計學(xué)意義,但甘精胰島素注射組低血糖事件明顯少于NPH組(甘精胰島素組3例,7.1% ; NPH組5例,35.7%.χ2＝7.0,P＝0.008).危險因素相關(guān)分析結(jié)果顯示,血糖達(dá)標(biāo)時甘精胰島素使用量與治療前FBG和BMI顯著相關(guān).
結(jié)論 每日注射一次中、長效胰島素聯(lián)合一次口服降糖藥的方案可使更多2型糖尿病患者血糖達(dá)標(biāo),長效甘精胰島素的應(yīng)用能減少低血糖事件的發(fā)生,這種簡便的治療方案可使患者依從性大大提高.理想的基礎(chǔ)胰島素的補(bǔ)充有利于全天血糖控制.
引用本文： 卜石,邢小燕,王娜,趙文惠,楊文英. 長效胰島素聯(lián)合口服降糖藥治療2型糖尿病的療效與安全性. 中國循證醫(yī)學(xué)雜志, 2004, 04(7): 464-467. doi: 復(fù)制
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