摘要
目的比较短期胰岛素泵(CSII)与多次皮下胰岛素(MSII)注射强化控制2型糖尿病(T2DM)的有效性和安全性。方法对解放军总院内分泌科2006年6月至2007年5月收治住院的96例糖化血红蛋白(HbA1c)>7.5%的T2DM患者随机分为2组,分别给予CSII和MSII进行短期强化达标治疗,比较两组治疗前后的多时点血糖、糖化血清蛋白(GSP)、血糖达标天数、达标时胰岛素总剂量及低血糖事件发生的差异。结果治疗后CSII组与MSII组静脉血空腹血糖(FBG)分别由(13.53±5.01)mmol/L和(12.25±3.49)mmol/L下降到(5.56±0.76)mmol/L和(6.07±0.97)mmol/L,CSII组FBG下降程度更大(P=0.005)。静脉血餐后2h血糖(2hPG)分别由(19.56±5.82)mmol/L和(18.69±3.98)mmol/L下降到(6.93±1.07)mmol/L和(7.28±1.54)mmol/L,两组间比较差异无统计学意义(P>0.05)。两组的7个时点指血血糖均显著降低,两组间差异无统计学意义(P>0.05)。但达标时最高与最低血糖差值CSII组明显小于MSII组(P=0.029),血糖曲线下面积CSII组明显小于MSII组(P=0.017)。CSII组与MSII组GSP分别由(407±79)μmol/L和(410±100)μmol/L下降到(266±74)μmol/L和(297±83)μmol/L,均有显著改善(P均<0.01),两组治疗后绝对下降值CSII组更显著(P<0.05)。CSII组血糖达标时间平均为(3.66±1.41)d,显著短于MSII组的(5.83±1.77)d(P<0.05)。CSII组在达标时和治疗第7天的胰岛素剂量分别是(40.23±7.47)U/d和(36.06±9.71)U/d,均显著少于MSII组的(47.71±17.74)U/d和(45.63±11.91)U/d(P均<0.05)。两组有症状性低血糖事件共35例次,CSII组与MSII组分别有15例次和20例次,其中CSII组血糖≤3.9mmol/L和≤2.8mmol/L的分别为7和0例次,MSII组分别为19和8例次,前者均少于后者。结论两种胰岛素强化治疗均能有效控制尚未胰岛素治疗的T2DM患者的血糖,促进短期血糖达标。但与MSII相比,CSII治疗在降低FBG、缩小血糖波动和整体血糖控制方面更显著,并能够缩短血糖达标时间,减少胰岛素用量和降低低血
Objective To compare the efficacy and safety of continuous subcutaneous insulin infusion （CSII, insulin pump） and multiple insulin injection （MSII） in controlling type 2 diabetes mellitus. Methods Ninety-six subjects in Chinese PLA General Hospital between June 2006 and May 2007 with HbAl c 〉 7.5% were randomized to receive CSII or MSII for intensive short-term treatment. Hereby the differences of the blood glucose profile, glycosylated serum protein （GDP） ,the days of blood glucose up to scratch,the insulin dose and the incidence of hypoglycemia episodes between the two groups before and after insulin therapy were compared and analyzed. Results The FBG decreased from （ 13.5 ± 5. O1 ） mmol/L in CSII and （ 12. 3 ± 3.49 ） mmol/L in MSII to （ 5.56 ± O. 76） mmol/L and （ 6, 07 ± O, 97 ） mmol/L, respectively （P 〈 0. 001 ）, and CSII group was much lower than MSII group （ P = 0. 005 ）. 2hPG of the two groups decreased from （ 19, 56 ±5, 82） mmol/L and （ 18, 69 _± 3.98） mmol/L to （6. 93 _± 1.07 ） mmol/L and （ 7.28 ± 1, 54 ） mmol/L, respec- tively. There was no statistic significance of this comparison （P 〉 0. 05 ）. The 7 points SMBG were also significantly de- creased in both groups. There were no statistic differences between the two groups （ P 〉 0. 05 ）. With regard to the maximal postprandial glycemic excursions （ MPGE ）, CSII group was much lower than MSII group （P = 0. 029）. The areas under glucose curve in CSII group were obviously smaller than that of MSII group （P =0. 017）. The serum GSP was significantly decreased from （407 ±79） μmol/L and （410 ± 100） μmol/ L to （266 ± 74） ixmol/L and （297 ± 83 ） μmol/L in two groups, respectively （P 〈 0. 001 ）, and the decreased values were bigger in CSII group than those in MSII group （P 〈 0.05 ）. The average teat-to-target duration in CSII （3.66 ± 1.41 ）d was much shorter than that in MSII （ 5.82 ± 1.76 ） d （ P 〈 0. 05 ）. The insulin dosage
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2008年第8期652-655,共4页
Chinese Journal of Practical Internal Medicine
关键词
2型糖尿病
胰岛素
胰岛素泵
低血糖
糖化血清蛋白
type 2 diabetes mellitus
intensive therapy
insulin pump
hypoglycemia
glycosylated serum protein
