地特胰岛素与中性鱼精蛋白锌胰岛素联合诺和龙对新诊断2型糖尿病患者血糖变异性影响的观察

摘要

目的 观察地特胰岛素或中性鱼精蛋白锌胰岛素(NPH)联合诺和龙治疗对新诊断T2DM患者血糖水平及其变异性的影响. 方法 将100例新诊断T2DM病患者随机分为两组,各50例,即地特胰岛素联合诺和龙治疗(A)组与NPH联合诺和龙治疗(B)组.治疗3个月后,采用动态血糖监测(CGMS)系统进行连续72 h的血糖监测,监测数值864个.观察平均血糖水平、一日内血糖最高值及最低值、血糖漂移最大幅度、血糖3.6～8.0 mmol/L所占一日内时间百分比. 结果 (1)治疗3个月后,两组FBG、2hBG和HbA1c均降低,差异有统计学意义(P＜0.05或P＜0.01)；而FBG、2hBG和HbA1c水平两组间比较差异无统计学意义(P＞0.05); (2)CGMS结果显示,两组间平均血糖水平差异无统计学意义[(7.2±1.4)vs(7.3±1.6)mmol/L,P＞0.05],但A组一日内血糖最高值、一日内血糖漂移最大幅度均低于B组[(9.2±2.0)vs(12.5±1.8)mmol/L,(5.8±1.6)vs(9.8±1.3)nmmol/L],A组血糖3.6～8.0 mmol/L所占一日内时间百分比高于B组[(82.4±6.5)％vs (73.1±9.4)％],差异有统计学意义(P＜0.01).A组低血糖发生率低于B组(12％vs34％,P＜0.05). 结论 地特胰岛素在改善T2DM患者血糖变异性方面优于NPH.%Objective To compare the effects of insulin Determir and NPH combined with repaglinide on glucose variability in newly diagnosed T2DM patients. Methods A total of 100 patients with newly diagnosed T2DM were randomized into two groups with 50 in each; one group (group A, Determir group) was treated with insulin Determir combined with repaglinide and the other (group B, NPH group) with NPH combined with repaglinide. After 3 months' treatment, the dynamic glycemia monitoring system (CGMS)was used for 72 h and 864 times of blood glucose were recorded. The average glucose levels, intraday highest and lowest glycemia, maximum amplitude of glycemic excursion, the average levels of pre- and post-prandial glycemia, and the percentage of glycemia drift accounted for intraday time were observed. Results (1) After 3 months' treatment, the FBG, 2 hBG, and HbA1c of both groups had a significant decrease in statistics (P<0. 05 or P<0. 01), while the levels of FBG, 2 hBG, and HbA1c were not statistically different between the two groups (P>0. 05). (2) The CGMS results showed that there was no significant difference in average glycemia levels between the two groups [(7. 2±1. 4) vs (7. 3±1. 6)mmol/L, P>0. 05]. However, the intraday highest glycemia and maximum amplitude of glycemic excursion were lower in the Determir group than in the NPH group [(9. 2 ±2. 0) vs (12.5±1.8)mmol/L, (5.8±1.6) vs (9. 8±1. 3)mmol/L]. The percentage of glycemia drift between 3. 6～8. 0 mmol/L accounted for the intraday time was significantly higher in the Determir group than in the NPH group (P<0. 05). And the incidence of hypoglycemia in the Determir group was lower than that in the NPH group (12% vs 34%, P<0. 05). Conclusion Insulin determir improves glycemia variability better than NPH.