摘要
目的 比较口服降糖药（OADs）血糖控制不佳的老年2型糖尿病患者加用基础胰岛素治疗与增加降糖药物治疗的疗效和安全性.方法 回顾性分析2004年1月至2011年12月于天津医科大学代谢病医院门诊就诊、血糖控制不佳的老年2型糖尿病患者746例,平均年龄69岁,糖化血红蛋白（HbA1c）7.5％ ～ 11.0％,空腹血糖（FBG）＞7.5 mmol/L,分为启动基础胰岛素治疗或增加OADs 2组,观察24周,比较2组血糖、OADs、体重变化和低血糖事件的发生率.组内治疗前后的比较用配对t检验;组间比较采用x2检验.结果 286例患者纳入最终分析,启动基础胰岛素治疗组（A组,n=176例）,增加OADs组（B组,n=110例）,A组FBG和HbA1c下降幅度明显大于B组（2.5 mmol/L比2.1 mmol/L,2.0％比1.7％,t=-5.86、-3.93,均P＜0.01）;A组HbA1c达标率明显高于B组[78.4％（138/176）比54.5％（60/110）,x2=18.1,P＜0.01],A组低血糖发生率明显低于B组[31.8％ （56/176）比51.8％（57/110）,x2=12.0,P＜0.01],2组体重变化差异无统计学意义.B组OADs剂量和种类明显高于A组.结论 OADs血糖控制不佳的老年2型糖尿病患者尽早启动基础胰岛素治疗是控制血糖安全有效的治疗方案.
Objective To assess the efficacy and safety of adding basal insulin to current oral antidiabetic drugs （OADs）regime in poorly controlled elderly patients with type 2 diabetes compared to increasing the OADs.Methods In this retrospective study,we observed 746 elderly outpatients （mean age 69 yrs,glycated hemoglobin A1c（HbA1c） 7.5％-11.0％ and fasting blood glucose（FBG）＞7.5 mmol/L）who were inadequately controlled with OADs for enrollment from our hospital specialist clinics from January 2004 to December 2011.All enrolled patients were divided into 2 groups according to either adding basal insulin to current therapy or increasing OADs.The changes of glucose control,OADs therapy,body weight and the incidence of hypoglycemic events were assessed and compared between the 2 groups during the 24-week observation period.Results A total of 286 patients were included in the final analysis,176 in the adding basal insulin group（Group A）and 110 in the increasing OADs group（Group B）.During the 24-week observation period,the reduction of HbA1c and FBG in the Group A were significantly larger than that in the Group B（2.5 mmol/L vs 2.1 mmol/L,2.0％ vs 1.7％,t=-5.86,-3.93,both P＜0.01）.HbA1c level＜7.0％ was achieved by 78.4％ patients（138/176）and 54.5％ patients（60/110）in the groups A and B,respectively（x2=18.1,P＜0.01）.The group A had fewer total hypoglycemic events compared with group B （31.5％ （56/176）vs 52％ （57/110）,x2=12.0,P＜0.01）.The patients in the group A had lower doses and number of oral antidiabetic drugs compared with the group B.There was no difference regarding weight gain between the 2 groups.Conclusions The addition of basal insulin to current OADs therapy may be an effective and safe option for poorly controlled elderly patients with type 2 diabetes.
出处
《中华糖尿病杂志》
CAS
CSCD
2014年第11期813-816,共4页
CHINESE JOURNAL OF DIABETES MELLITUS
关键词
糖尿病
2型
老年人
基础胰岛素
口服降糖药物
Diabetes mellitus,type 2
Elderly
Basal insulin
Oral antidiabetic agents
