長效胰島素聯合口服降糖藥治療2型糖尿病的療效與安全性_《中國循證醫學雜志》

作者：

卜石 , 邢小燕 , 王娜 , 趙文惠 , 楊文英

中日友好醫院內分泌科,北京,100029;

關鍵詞：

甘精胰島素格列吡嗪 2型糖尿病

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目的　比較每日注射一次長效重組甘精胰島素注射液與中效低糖蛋白鋅人胰島素(NPH)聯合口服格列吡嗪控釋片治療2型糖尿病的血糖控制情況和低血糖的風險.
方法　56例口服降糖藥血糖控制不理想的2型糖尿病患者按3：1隨機分為甘精胰島素治療組(n=42)和NPH組(n=14).分別采用每日晨起口服格列吡嗪控釋片5 mg,每晚10點注射重組甘精胰島素和每日晨起口服格列吡嗪控釋片5mg,每晚10點注射中效NPH胰島素.根據空腹血糖(FBG)水平調整胰島素用量,以兩組FBG均達到＜6.7 mmol/L為治療目標,共治療12周,觀察血糖控制和低血糖事件發生情況,分析FBG達標時所用甘精胰島素日劑量與治療前FBG、BMI和病程的關系.
結果　治療后兩組Alc及全天血糖譜均較基線水平明顯下降,兩組下降幅度比較無統計學意義,但甘精胰島素注射組低血糖事件明顯少于NPH組(甘精胰島素組3例,7.1% ; NPH組5例,35.7%.χ2＝7.0,P＝0.008).危險因素相關分析結果顯示,血糖達標時甘精胰島素使用量與治療前FBG和BMI顯著相關.
結論　每日注射一次中、長效胰島素聯合一次口服降糖藥的方案可使更多2型糖尿病患者血糖達標,長效甘精胰島素的應用能減少低血糖事件的發生,這種簡便的治療方案可使患者依從性大大提高.理想的基礎胰島素的補充有利于全天血糖控制.

引用本文： 卜石,邢小燕,王娜,趙文惠,楊文英. 長效胰島素聯合口服降糖藥治療2型糖尿病的療效與安全性. 中國循證醫學雜志, 2004, 04(7): 464-467. doi: 復制

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1. ［1］UKPDS Study Group.Stratton IM,Adler AI,Neil HAW,Matthews DR,Manley SE,Cull CA,Hadden D,Turner RC,Holman RR.Association of glycaemia with macrovascular and microvascular complications of Type 2 diabetes:prospective observational study (UKPDS 35) [J].BMJ,2000; 321(12):405-412.
2. ［2］UKPDS Study Group.Klein R,Klein BE,Moss SE.Relation of glycemic control to diabetic microvascular complications indiabetes mellitus[J].Ann Intern Med,1996;124(1 Pt 2):90-96.
3. ［3］Wright A,Burden ACF,Paisey RB.Sulfonylurea Inadequacy:Efficacy of addition of insulin over 6 years in patients with type 2 diabetes in the UK Prospective Diabetes Study (UKPDS 57)[J].Diabetes Care,2002; 25(2):330-336.
4. ［4］HOE 901/3002 Study Group.Less nocturnal hypoglycemia and better post-dinner glucose control with bedtime insulin glargine compared with bedtime NPH insulin during insulin combination therapy in type 2 diabetes[J].Diabetes Care,2000; 23(8):1 130-1 136.
5. ［5］Riddle MC,Rosenstock J,Gerich J.Insulin Glargine 4002 Study Investigators.The treat-to-target trial:randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients[J].Diabetes Care,2003; 26(11):3 080-3 086.
6. ［6］UKPDS Study Group.Overview of six years’ therapy of type 2 diabetes-a progressive disease (UKPDS 16)[J].Diabetes Care,1995; 44(11):1 249-1 258.
7. ［7］Turner RC,Cull CA,Frighi V,Holman RR.Glycemic control with diet,sulfonylurea,metformin,or insulin in patients with type 2 diabetes mellitus:progressive requirement for multiple therapies (UKPDS 49).UK Prospective Diabetes Study (UKPDS) Group[J].JAMA,1999; 281(21):2 005-2 012.
8. ［8］Matthaei S.Endocrine review[M],21(6):585-618.

《中國循證醫學雜志》

長效胰島素聯合口服降糖藥治療2型糖尿病的療效與安全性

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《中國循證醫學雜志》

長效胰島素聯合口服降糖藥治療2型糖尿病的療效與安全性

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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