甘精胰岛素与预混胰岛素治疗2型糖尿病的疗效和安全性比较

·12 ·中国医师进修杂志2006 年4 月第29 卷第4 期内科版Chin J Postgrad Med ,April 2006 ,V ol. 29 ,No. 4A

·临床论著·

甘精胰岛素与预混胰岛素治疗2 型

糖尿病的疗效和安全性比较

周桂兰李竞毕会明王芳

量少。

【关键词】甘精胰岛素; 预混胰岛素; 2 型糖尿病

【摘要】目的在口服降糖药不能良好控制血糖的情况下,加用每日1 次甘精胰岛素或加用

每日2 次预混胰岛素治疗,比较这两种方案的疗效和低血糖的风险。方法40 例用口服降糖药血

糖控制不良的 2 型糖尿病患者随机分为甘精胰岛素组(简称甘精组) 和预混胰岛素组(诺和灵30R ,

简称预混组),每组各20 例。所有患者在原有的口服降糖药不变的基础上,甘精组每晚10 时注射

甘精胰岛素1 次;预混组每日早晚餐前分别注射诺和灵30R 预混胰岛素。根据空腹血糖( FB G) 的

水平,每周调整胰岛素剂量,以FB G 小于5.6 mmol/L 为治疗目标,共治疗16 周。观察血糖控制和

低血糖发生情况。结果治疗后两组的FB G 在4 周和16 周都明显下降,但甘精组的下降幅度明

显大于预混组,差异有统计学意义( P < 0. 01) 。两组的糖化血红蛋白( HbA1c) 在16 周时也明显的

下降,甘精组的下降幅度稍优于预混组,但二者的差异无统计学意义( P > 0. 05) 。到达终点时预混

组的胰岛素用量明显大于甘精组

混组(甘精组3 例,15 %; 预混组9 例,45%) ,χ2 =4.285, P < 0. 05 。结论单用口服降糖药不能较

好控制血糖时,加用每日 1 次甘精胰岛素或加用每日 2 次预混胰岛素进行治疗,均能达到明显的

降糖效果。甘精胰岛素与预混胰岛素相比,降低FB G 的效果更好,低血糖的发生率低,胰岛素的用

,差异有统计学意义( P < 0. 05) 。甘精组低血糖事件明显少于预

Comparison of eff icacy and safety in treatment of type 2 diabetic mellitus between glargine quaque and

mixed insulin ZHOU Gui -lan, LI Jing, BI Hui -ming, WANG Fang. Department of En2 docrinology , The People′sHospitalof WuhanUniversity,Wuhan 430060 , China

【Abstract 】Objective To compare the efficacy and the risk of hypoglycemia of glargine quaque

die and mixed insulin bis in die on the condition of controlling the blood glucose unsuccessfully with oral

drugs. Methods Forty type 2 diabetes patients which could not control the blood glucose successfully

with drugs were divided into two groups randomly:glargine group (20 cases) and mixed insulin group

(20 cases) . Without any change of oral drugs , the patients in glargine group were injected with the

glargine hypodermically once at 10 O’clock every night and the patients in mixed insulin group were in2

jected with the mixed insulin (Novolin 30R) hypodermically before the meal of morning and evening re2

spectively for 16 weeks. The doses of insulin were adjusted each week according to the level of fasting

bloodglucose (FBG) reachingtheaimoflessthan5.6mmol/L. Results The FBGof two groups dropped obviously on the 4th and 16th week with the treatment , but the extent of the descent were greater in glargine group than in mixed insulin group and both of the values of P were less than 0.

01.

The level of HbA1c in two groups fell markedly but the difference between them were not significant ( P

> 0. 05) . At the end of the experiment the doses of mixed insulin group were higher than that of glargine group significantly ( P < 0. 05) . The incident of hypoglycemia in glargine group were lower than

in mixed insulin group evidently (3 patients in glargine group , 9 patients in mixed insulin group ,χ2 =4.

285 , P < 0. 05) . Conclusion On the condition of controlling the blood glucose unsuccessfully with o2

raldrugs,bothoftheglargineandthemixedinsulinhavevisibleeffectsofcontrollingthe FBGbut the former have better efficacy ,lower risk of hypoglycemia and less dose than the latter.

作者单位:430060 武汉大学人民医院内分泌科

中国医师进修杂志2006 年 4 月第29 卷第 4 期内科版Chin J Postgrad Med ,April 2006 ,V ol. 29 ,No. 4A ·13 ·

【Key words 】Glargine ; Mixed insulin ; Type 2 diabetes mellitus

近年来2 型糖尿病的发病率越来越高,但据统

计有2/ 3 的患者治疗不能达标,尤其是病程长、单独

使用口服降糖药的患者。糖尿病控制与并发症的临

床试验(DCCT) 、英国前瞻性糖尿病研究( U KPDS)

等多项循证医学研究已使人们对强化血糖控制的意