胰岛素泵与皮下注射胰岛素强化治疗初发2型糖尿病的疗效对比
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胰岛素泵与皮下注射胰岛素强化治疗初发2型糖尿病的疗效对比目的:探讨胰岛素泵与胰岛素皮下注射强化疗法治疗初发2型糖尿病的临
床疗效。方法:选取120例2型糖尿病初发患者并按随机数字表法分为两组,A 组(胰岛素泵强化治疗)58例和B组(胰岛素皮下注射强化治疗)62例,观察两组治疗前、治疗2周及治疗6个月后空腹血糖(FBG)、餐后2 h血糖(PBG2 h)、糖化血红蛋白(HbA1c)、空腹C-肽(C-P)及餐后2 h C-P(C-P 2 h)及血糖达标时间、胰岛素用量、低血糖发生次数。结果:两组患者治疗后,空腹血糖、餐后2 h血糖水平、糖化血红蛋白(HbA1c)均下降(P<0.05),空腹血清C-P、C-P 2 h均升高(P<0.05);治疗6个月A组空腹血清C-P、C-P 2 h升高较B组明显,比较差异有统计学意义(P<0.05);治疗前后A组与B组空腹血糖、餐后2 h血糖水平比较差异均无统计学意义。A组胰岛素用量、血糖达标时间、低血糖次数明显低于B组,比较差异有统计学意义(P<0.05)。结论:胰岛素泵强化治疗初发2型糖尿病临床疗效与皮下注射强化治疗疗效相当,但前者可缩短血糖达标时间,减少胰岛素用量,降低低血糖发生率,能更快、更平稳地控制血糖,是治疗初发2型糖尿病的首选方案。
标签:胰岛素泵;强化治疗;初发2型糖尿病
Effect Comparison of Insulin Pump and Subcutaneous Insulin Infusion Intensive Therapy in Treating Incipient Type 2 Diabetes/CHU Jian-guo.//Medical Innovation of China,2015,12(04):011-013
【Abstract】Objective:To study the clinical effect of the intensive therapy with insulin pump and subcutaneous insulin infusion in treating incipient type 2 diabetes.Method:120 patients with incipient type 2 diabetes were randomly divided into two groups,58 in Group A (insulin pump intensive therapy)and 62 in Group B (subcutaneous insulin infusion intensive therapy).Changes of fasting blood glucose (FBG),BG 2 hours after meal (PBG2 h),glycosylated emoglobin (HBA1C),fasting C-peptide(C-P)and C-P 2hrs after meal were observed,and the time of BG to target,insulin dosage,and the frequency of hypoglycaemia before and after treatment, 2 weeks and 6 months after treatment were also observed.Result:After treatment,FBG,BG 2 hrs after meal and HBA1C were lower for the patients in both groups (P<0.05),while fasting C-P、C-P 2 h were elevated (P<0.05).After 6 months’treatment,the increase in fasting C-P and C-P 2 h in Group A was significantly elevated than those in Group B (P<0.05).The differences of FBG and BG 2 h had no statistical significance.Insulin dosage,time of BG to target and the frequency of hypoglycaemia were obviously lower than those of Group B (P<0.05).Conclusion:The clinical effect of insulin pump therapy to incipient type 2 diabetes is almost equal to that of subcutaneous insulin infusion,whereas the former could shorten the time of blood glucose to target,reduce the dosage of insulin and the incidence of hypoglycemia with a quicker and smooth blood glucose control.The insulin pump therapy should be the first choice to the incipient
type 2 diabetes patients.
【Key words】Insulin pump;Intensive therapy;Incipient Type 2 Diabetes
First-author’s address:Chifeng No.2 Hospital,Chifeng 024000,Chinadoi:10.3969/j.issn.1674-4985.2015.04.004
糖尿病发病率不断上升,急、慢性并发症严重影响生活质量。血糖达到理想水平是预防和减少糖尿病各种并发症的重要措施。本研究采用胰岛素泵持续皮下输注赖脯胰岛素与三餐前皮下注射进行对比,比较两种治疗方案对血糖控制不佳的初发2型糖尿病(T2DM)患者血糖控制情况,研究对血糖明显升高的初诊T2DM患者尽早使用胰岛素泵治疗的必要性。
1 资料与方法
1.1 一般资料2010年8月-2011年12月住内分泌科初发2型糖尿病患者120例,男66例,女54例,年龄30~64岁,体重指数(BMI)为(27.6±4.5),随机数字表法分为两组,A组(胰岛素泵强化治疗)58例和B组(胰岛素皮下注射强化治疗)62例。2型糖尿病的诊断按WHO1999年诊断标准[1],糖化血红蛋白(HbA1c)为9.0%~1
2.0%或空腹血糖(FBG)10.0~15.0 mmoL/L。排除标准:合并糖尿病急、慢性并发症;甲状腺功能异常;严重肝、肾功能损害;心功能不全;近期有严重感染、手术、急性心肌梗死等应激事件。两组年龄、性别、BMI、HbA1c、FBG治疗前比较差异均无统计学意义(P>0.05),具有可比性。
1.2 治疗方法A组使用美敦力712型胰岛素泵,持续输注赖脯胰岛素;B 组三餐前皮下注射赖脯胰岛素,睡前皮下注射甘精胰岛素。患者均接受糖尿病教育,饮食,适量运动。强化治疗2周左右出院,改为口服药物治疗;每2~4周门诊随诊1次。
1.3 观察指标两组均用罗氏血糖仪监测指尖血糖,7次/d,包括三餐前及三餐后2 h、凌晨3:00时。低血糖:血糖≤3.9 mmol/L;严重低血糖:血糖≤
2.8 mmol/L
或昏迷。血糖控制目标为FBG 4.0~6.0 mmol/L,PBG 4.0~8.0 mmol/L。入院时、治疗2周及治疗6个月后抽静脉血检查。观察患者治疗前、治疗2周及治疗6个月后FBG、PBG 2 h、HbA1c、空腹C-肽(C-P)及餐后2 h C-P(C-P 2 h)以及低血糖发生次数。
1.4 统计学处理使用SPSS 11.5统计软件进行分析,计量资料组内治疗前后及两组间治疗后比较用t检验,P<O.05为差异有统计学意义。
2 结果
两组患者治疗后,空腹血糖、餐后2 h血糖水平、糖化血红蛋白(HbA1c)均下降(P<0.05),空腹血清C-P、C-P 2 h均升高(P<0.05);治疗6个月A组