目的观察在门诊的2型糖尿病患者中，使用二甲双胍联合那格列奈控制血糖不佳，不改变口服药，加用每天注射1次地特胰岛素或低精蛋白锌胰岛素，比较两种胰岛素方案的疗效。方法血糖控制不佳的2型糖尿病患者78例，随机分成2组。治疗组为40例，平均年龄（46±9.8）岁，男性25例，女性15例，予联用地特胰岛素治疗；对照组38例，平均年龄（45±8.9）岁，男性22例，女性16例，予联用低精蛋白锌胰岛素，疗程12周。结果各组治疗前后的空腹血糖、餐后2h血糖、糖化血红蛋白(HbA1c)有显著差异（P＜0.05）。治疗后治疗组的空腹血糖由（9.9±1.3）mmol/L降至（6.9±0.9）mmol/L，餐后血糖从（12.2±2.2）mmol/L降至（8.4±0.7）mmol/L，糖化血红蛋白从（8.8±0.5）%降至（6.6±0.9）%。对照组空腹血糖由（9.8±1.2）mmol/L降至（7.0±0.8）mmol/L，餐后血糖从（12.5±2.3）mmol/L降至（8.5±0.6）mmol/L，糖化血红蛋白从（8.7±0.6）%降至（6.7±0.8）%。对照组体质量指数增加，但与治疗组仍无统计学差异。治疗组发生低血糖事件5次，对照组发生低血糖事件11次，治疗组脱落3例（3/40，7.5%），对照组脱落5例（5/38，13.8%）。结论地特胰岛素联合那格列奈、二甲双胍治疗2型糖尿病，血糖控制达标率提高，不增加体质量，低血糖发生率低，临床使用较安全、放便，患者依丛性高。%Objective To compare the effect of two insulin therapic schemes in treating type 2 diabetes mellitus patients. Both schemes use metformin and nateglinide to control poor glycaemic. One scheme adds injecting insulin detemir per day, the other one adds injecting isophane insulin per day. Methods 78 patients of poorly glycaemic controlled type 2 diabetes mellitus were divided into two groups randomly. 40 cases of the treatment group, average age (46 ±9.8)years, 25 males and 15 females, were given combined insulin detemir therapies;38 cases of the control group, average age 45±8.9, 22 males and16 females were given combined isophane insulin. The treatment lasted for 12 weeks. Results After treatment, for the treatment group, the fasting glucose level decreased from (9.9±1.3)mmol/L to(6.9±0.9)mmol/L, postprandial glycated hemoglobin level from (12.2±2.2)mmol/L to(8.4±0.7)mmol/L, hypoglycemia from (8.8±0.5)%to(6.6±0.9)%;For the control group, the fasting glucose level decreased from (9.8±1.2)mmol/L to (7.0±0.8)mmol/L,postprandial glycated hemoglobin level from (12.5±2.3)mmol/L to (8.5±0.6)mmol/L, hypoglycemia from(8.7±0.6)%to (6.7±0.8)%. After treatment of 12 weeks, there were signiifcant statistical differences for the fasting blood glucose level, 2-hr postprandial blood glucose level and glycated hemoglobin value (HbA1c) before and after treatment(P<0.05). there were 5 cases of hypoglycemia for the treatment group, 11 cases for the contrast group;2 cases of expulsion for treatment group(3/40,7.5%), 5 cases for contrast group(5/38, 13.8%). The body mass index of contrast groups is up, but no statistical difference with that of treatment group. Conclusions The scheme of uniting insulin detemir with metformin and nateglinide has advantages of improving the achievement rate of glycaemic control, little impact on patients’ weight, low incidence of hypoglycemia, safe usage, convenience and good clients’ compliance.
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