2019 年第 2 期 第 14 卷

初发与血糖控制不佳的2型糖尿病患者应用门冬胰岛素30注射液强化治疗的效果及安全性比较

Efficacy and safety of insulin aspart 30 in initial type 2 diabetes and long course type 2 diabetes with poor glycemic control

作者：仲维莉邹国良

英文作者：

单位：150040哈尔滨，黑龙江中医药大学附属第一医院内分泌科（仲维莉），心血管一科（邹国良）

英文单位：

关键词：糖尿病，2型；门冬胰岛素30注射液；强化治疗

英文关键词：

• 摘要：

• 【摘要】目的    探讨初发与血糖控制不佳的2型糖尿病患者应用门冬胰岛素30注射液强化治疗的效果及安全性。方法    选取2016年1月至2018年6月黑龙江中医药大学附属第一医院收治的2型糖尿病住院患者126例，其中初发(病程<1年)的2型糖尿病66例（A组），病程>5年血糖控制不佳的2型糖尿病60例（B组）。2组患者均在饮食、运动干预的基础上应用门冬胰岛素30注射液皮下注射治疗3次/d。比较2组患者入院时、治疗2周出院时以及治疗3个月随访时三餐前后各时点指尖血糖的变化，住院期间血糖控制达标的每日胰岛素总量,治疗3个月随访时糖化血红蛋白（HbA1c）和降糖方案的变化，以及治疗3个月期间低血糖的发生率。结果    A组和B组治疗2周出院时以及治疗3个月随访时空腹、早餐后、午餐前、午餐后、晚餐前、晚餐后和睡前指尖血糖水平均低于入院时水平，差异均有统计学意义（均P<0.05）。A组住院期间血糖控制达标的每日胰岛素总量低于B组［(36±5)U/d比（52±12）U/d］，差异有统计学意义（P<0.05）。入院时2组 HbA1c水平比较差异无统计学意义（P＞0.05），A组和B组治疗3个月随访时HbA1c水平均低于入院时［（7.3±0.3）%比（9.8±0.8）%，（7.5±0.5）%比（9.8±0.6）%］，差异均有统计学意义（均P<0.05）。治疗3个月随访时,A组66例患者中18例（27.3%）改为门冬胰岛素30注射液每日2次皮下注射，22例（33.3%）改为口服降糖药物治疗，26例（39.4%）仅采用饮食、运动疗法即可控制血糖;B组60例患者仍继续应用胰岛素治疗，6例（10.0%）患者改为每日2次皮下注射门冬胰岛素30注射液，16例（26.7%）患者继续维持强化治疗方案，38例（63.3%）患者改为每日2次皮下注射门冬胰岛素30注射液联合口服降糖药物治疗。治疗3个月期间2组低血糖发生率比较差异无统计学意义（P＞0.05）。结论    门冬胰岛素30注射液强化治疗对初发2型糖尿病和血糖控制不佳的2型糖尿病患者均疗效较好，安全性较高。

• 【Abstract】Objective    To analyze the efficacy and safety of insulin aspart 30 in the treatment of initial type 2 diabetes and long course type 2 diabetes with poor glycemic control. Methods    Totally 126 patients with type 2 diabetes were enrolled from First Affiliated Hospital, Heilongjiang University of Chinese Medicine between January 2016 and June 2018, including 66 cases of initial diabetes(course of disease<1 year, group A) and 60 cases with poor glycemic control(course of disease>5 years, group B). All patients were treated with insulin aspart 30 subcutaneous injection 3 times per day on the basis of diet and exercise intervention. Preprandial and postprandial blood glucose levels were tested at admission, 2 weeks and 3 months after treatment. Daily insulin dose to reach the standard blood glucose level was recorded during hospitalization. Glycosylated hemoglobin（HbA1c） level, changes of hypoglycemic regimen and incidence of hypoglycemia were analyzed 3 months after treatment. Results    Preprandial and postprandial blood glucose levels of 3 meals and blood glucose level at bedtime 2 weeks and 3 months after treatment were significantly lower than those at admission in both group A and group B（P<0.05）. Daily insulin dose during hospitalization in group A was significantly lower than that in group B［(36±5)U/d vs (52±12)U/d］(P<0.05). HbA1c level at admission was similar between groups(P>0.05). HbA1c level 3 months after treatment was significantly lower than that at admission in group A and group B［(7.3±0.3)% vs (9.8±0.8)%, (7.5±0.5)% vs (9.8±0.6)%］(P<0.05). At 3 months after treatment, 18 of 66 patients in group A(27.3%) had insulin aspart 30 injection 2 times per day; 22 patients(33.3%) took hypoglycemic agents orally; 26 patients(39.4%) stopped hypoglycemic medication; all the 60 patients in group B still need insulin subcutaneous injection; 6 patients(10.0%) had insulin aspart 30 injection 2 times per day; 16 patients(26.7%) continued to have insulin aspart 30 injection 3 times per day; 38 patients(63.3%) had insulin aspart 30 injection 2 times per day plus oral hypoglycemic agents. There was no significant difference of the incidence of hypoglycemia between groups during 3 months of treatment(P>0.05). Conclusion    Intensive insulin aspart 30 treatment is safe and effective in treating initial type 2 diabetes and long course type 2 diabetes with poor glycemic control.