胰岛素泵持续皮下胰岛素输注转为多次皮下胰岛素注射治疗2型糖尿病的疗效比较及用量探讨

摘要

Objective To assess the insulin dose and blood glucose fluctuation in Type 2 Diabetes with CSII and MDII. Methods 223 Type 2 Diabetic patients were treated with CSII to control gulucose level. When their glucose levels reached the target, the mode of treatment was switched to MDII. When the glucose levels reached the target, the daily required dose of insulin and the level of blood glucose in each period were recorded for comparison. Results When blood glucose reached the target, the daily insulin dose of MDII was ( 48. 7 ± 17. 3 ) U/d, and there was no statistical difference between CSII ( 47. 9 ± 15. 9 ) U/d and MDII. Under the MDII treatment, the insulin dose before bedtime accounted for 28. 0% of total quantity, and it was 25. 7% before breakfast and 23. 7% before lunch, and before dinner was 22. 6% , which was the lowest percentage. The average daily blood glucose during CSII was ( 8. 39 ± 1. 48 ) mmol/L and it was ( 8. 20 ± 1. 33 ) mmol/L during MDII. There was no statistical difference between CSII and MDII ( P >0. 05 ). The incidence of hypoglycaemia under MDII treatment was 23. 32% , which was statistical more than that of CSII ( 14. 35% ) ( P <0. 05 ). The blood glucose fluctuation of MDII was greater than that of CSII. Conclusion ( 1 ) There was no difference in insulin dose and the level of blood glucose between CSII and MDII. But MDII was greater than CSII in the incidence of hypoglycaemia and blood glucose fluctuation. ( 2 ) With the MDII treatment, the insulin dose before bedtime accounted for 28. 0% of total quantity. Before breakfast was 25. 7% , before lunch was 23. 7% ,　before dinner was 22. 6%.%目的 观察2型糖尿病(T2DM)患者经过胰岛素泵持续皮下胰岛素输注(continuous subcutaneous insulin infusion,CSII)短期强化治疗使血糖控制平稳后,如何由胰岛素泵剂量转换为多次皮下胰岛素注射(multiple daily insulin injections,MDII)用量及治疗前后血糖波动情况.方法 223例T2DM患者接受CSII治疗.血糖控制平稳后改为MDII,观察两者之间的剂量关系,同时比较转换前后全日血糖波动情况.结果 CSII治疗血糖达标时胰岛素用量为(47.9±15.9)U/d,转化为MDII时胰岛素用量(48.7±17.3)U/d,二者比较差异无统计学意义(P＞0.05).CSII转化为MDII后睡前胰岛素剂量所占的比例最大,为28.0%;早餐前胰岛素剂量占总量的25.7%,午餐前占23.7%,晚餐前最少,为22.6%.CSII治疗时日平均血糖为(8.39±1.48)mmol/L,MDII时为(8.20±1.33)mmol/L,二者比较差异无统计学意义(P＞0.05);CSII治疗低血糖发生率为14.35%,而MDII治疗低血糖发生率为23.32%,二者比较差异有统计学意义(P＜0.05).MDII治疗时日内血糖波动与CSII治疗比较,差异有统计学意义(P＜0.05).结论 (1)CSII转化为MDII时血糖及胰岛素用量无显著变化,但低血糖发生率及日内血糖波动较CSII治疗期间有增加;(2)CSII转化为MDII后睡前胰岛素用量占的比例最大,为28.0%,早餐前占25.7%,午餐前占23.7%,晚餐前占22.6%.