2型糖尿病肥胖患者口服降糖藥失效啟用胰島素治療方案的探討_West China Medical Journal

Authors：

CHEN Yu-hua, CHEN Min, QIU Ping, WANG Yan, ZHAO Yu, LI Ling, YAN Zong-xun;

Corresponding?author：

Keywords：

2型糖尿病; 肥胖; 胰島素; 治療

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

【摘要】　目的　探討2型糖尿病肥胖患者在口服降糖藥繼發失效的情況下啟用胰島素治療方案的選擇。　方法　選擇2009年1月-2010年12月間40例口服降糖藥失效的2型糖尿病肥胖患者，隨機分為兩組，每組20例。A組原口服藥不變，睡前聯用長效胰島素（商品名:來得時）治療，B組停用口服藥，于早晚餐前使用預混胰島素（商品名：諾和靈30R），治療共3個月，分別于治療前后觀察空腹血糖、餐后2 h血糖、糖化血紅蛋白、血脂、血壓、體質量指數的變化，記錄低血糖發生次數，并填寫問卷調查表，評估患者對治療方案的滿意度和接受度。　結果　兩個組治療后空腹血糖、餐后2 h血糖、糖化血紅蛋白均較治療前明顯下降（P lt;0.01），而血脂、血壓變化不大；但B組體質量指數有輕微升高（P gt;0.05），且每日胰島素用量較A組更大（P lt;0.01），低血糖反應更多（P lt;0.05），滿意度和接受度不如A組高（P gt;0.05）。　結論　對2型糖尿病肥胖患者在口服降糖藥繼發失效的情況下啟用胰島素治療，選用口服降糖藥聯合基礎胰島素的治療方案具有作用佳、安全性好，體重增加不明顯，患者依從性更高的特點。
【Abstract】　Objective　 To investigate the selection of insulin therapy for obese patients with type 2 diabetes mellitus (T2DM) after the failure of oral antihyperglycemic drugs.　Methods　 Forty obese T2DM subjects who failed the therapy of oral antihyperglycemic drugs between January 2009 and December 2010 were divided into 2 groups randomly. Patients in group A (n=20) continued using oral antihyperglycemic agents while long-acting insulin (Lantus) was added at bedtime; Patients in group B (n=20) used premixed insulin (Novolin 30R) injection before breakfast and supper instead of the oral drugs. The treatment lasted for 3 months for both groups. Fasting plasma glucose (FPG), blood glucose 2 hours after breakfast (2hPG), glycated hemoglobin (HbA1c), serum lipids, blood pressure, and body mass index (BMI) were examined before and after the trial respectively. We evaluated the satisfaction and acceptance level in all subjects who underwent the treatment with questionnaires.　Results　 FPG, 2hPG, HbA1c after the treatment were significantly lower than those before the treatment in both two groups (P lt;0.01), while serum lipids and blood pressure showed no significant differences. Patients in group B had slightly higher BMI (P gt;0.05) after the treatment. Compared with patients in group A, they needed a larger insulin dosage (P lt;0.01), had higher hypoglycemia frequency (P lt;0.05) and lower satisfaction and acceptance level (P gt;0.05).　Conclusion　 For obese patients with T2DM who have failed the therapy of oral antihyperglycemic drugs, combined oral antihyperglycemic drugs with basic insulin has better effects, security, and compliance, and less weight gain.

Citation： Investigate on the Selection of Insulin Therapy for Obese Patients with Type Diabetes Mellitus after the Failure of Oral Antihyperglycemic Drugs. 2型糖尿病肥胖患者口服降糖藥失效啟用胰島素治療方案的探討. West China Medical Journal, 2011, 26(11): 1636-1638. doi: Copy

1.	武陽豐, 周北凡, 陶壽淇, 等. 我國中年人群的超重率和肥胖率現狀及發展趨勢[J]. 中華流行病學雜志, 2002, 23(1): 11-15.
2.	Yang W, Lu J, Weng J, et al. Prevalence of diabetes amang men and women in China[J]. N Engl J Med, 2010, 362(12):1090-1101.
3.	潘長玉, 中國區合作調查組. 中國糖尿病控制現狀——指南與實踐的差距亞洲糖尿病治療現狀調查1998, 2001及2003年中國區結果介紹[J]. 國外醫學?內分泌學分冊,2005, 25(3): 174-178.
4.	項坤三, 紀立農, 向紅丁, 等. 中華醫學會糖尿病學分會關于代謝綜合癥的建議[J]. 中華糖尿病雜志, 2004,12(3): 156-161.
5.	洪潔, 顧衛瓊, 張翼飛, 等. 肥胖和非肥胖2型糖尿病患者胰島素敏感性和B細胞功能研究[J].中國糖尿病雜志, 2003, 11(2): 96-99.
6.	Turner RC, Cull CA, Frighi V, et al. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49)[J]. JAMA, 1999, 281(21): 2005-2012.
7.	Holman RR,Thorne KI,Farmer AJ,et al. Addition of biphasic,prandial, or basal insulin to oral therapy in type 2 diabetes[J]. N Engl J Med, 2007, 357(17): 1716-1730.
8.	楊文英. 如何選擇不同的胰島素治療方案以提高胰島素治療的技巧[J]. 國際內分泌代謝雜志, 2006, 26(3): 195-197.
9.	Wang F, Carabino JM, Vergara CM. Insulin glargine:a systematic review of a long-acting insulin analogue[J]. Clin Ther, 2003, 25(6): 1541-1577.
10.	胡予, 陸志強. 甘精胰島素治療對糖尿病患者生活質量的影響[J]. 國際內分泌代謝雜志, 2006, 26(2): 附錄2-1-附錄2-2.
11.	Kann PH, Washcher T, Zaekova V, et al. Staring insulin therapy in type 2 diabetes: twice-daily biphasic insulin aspart30 plus metformin versus one daily insulin glargine plus glimepiride[J]. Exp Clin Endocrinol Diabetes, 2006, 114 (9): 527-532.
12.	楊俏玲, 黃建寧, 楊銳英. OAD聯合甘精胰島素與預混胰島素治療2 型糖尿病的療效比較[J]. 寧夏醫科大學學報, 2009, 31(5): 681-683.
13.	胡茂清, 羅玉, 楊雪, 等. 甘精胰島素聯合二甲雙胍治療2 型糖尿病患者的有效性和安全性[J]. 華西醫學, 2009, 24(5): 1144-1146.
14.	于學靜, 于萍, 史為伍, 等. 甘精胰島素聯合口服藥物治療2型糖尿病肥胖患者的臨床觀察[J]. 實用糖尿病雜志, 2010, 6(4): 51-52.

1. 　武陽豐, 周北凡, 陶壽淇, 等. 我國中年人群的超重率和肥胖率現狀及發展趨勢[J]. 中華流行病學雜志, 2002, 23(1): 11-15.
2. 　Yang W, Lu J, Weng J, et al. Prevalence of diabetes amang men and women in China[J]. N Engl J Med, 2010, 362(12):1090-1101.
3. 　潘長玉, 中國區合作調查組. 中國糖尿病控制現狀——指南與實踐的差距亞洲糖尿病治療現狀調查1998, 2001及2003年中國區結果介紹[J]. 國外醫學?內分泌學分冊,2005, 25(3): 174-178.
4. 　項坤三, 紀立農, 向紅丁, 等. 中華醫學會糖尿病學分會關于代謝綜合癥的建議[J]. 中華糖尿病雜志, 2004,12(3): 156-161.
5. 　洪潔, 顧衛瓊, 張翼飛, 等. 肥胖和非肥胖2型糖尿病患者胰島素敏感性和B細胞功能研究[J].中國糖尿病雜志, 2003, 11(2): 96-99.
6. 　Turner RC, Cull CA, Frighi V, et al. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49)[J]. JAMA, 1999, 281(21): 2005-2012.
7. 　Holman RR,Thorne KI,Farmer AJ,et al. Addition of biphasic,prandial, or basal insulin to oral therapy in type 2 diabetes[J]. N Engl J Med, 2007, 357(17): 1716-1730.
8. 　楊文英. 如何選擇不同的胰島素治療方案以提高胰島素治療的技巧[J]. 國際內分泌代謝雜志, 2006, 26(3): 195-197.
9. 　Wang F, Carabino JM, Vergara CM. Insulin glargine:a systematic review of a long-acting insulin analogue[J]. Clin Ther, 2003, 25(6): 1541-1577.
10. 　胡予, 陸志強. 甘精胰島素治療對糖尿病患者生活質量的影響[J]. 國際內分泌代謝雜志, 2006, 26(2): 附錄2-1-附錄2-2.
11. 　Kann PH, Washcher T, Zaekova V, et al. Staring insulin therapy in type 2 diabetes: twice-daily biphasic insulin aspart30 plus metformin versus one daily insulin glargine plus glimepiride[J]. Exp Clin Endocrinol Diabetes, 2006, 114 (9): 527-532.
12. 　楊俏玲, 黃建寧, 楊銳英. OAD聯合甘精胰島素與預混胰島素治療2 型糖尿病的療效比較[J]. 寧夏醫科大學學報, 2009, 31(5): 681-683.
13. 　胡茂清, 羅玉, 楊雪, 等. 甘精胰島素聯合二甲雙胍治療2 型糖尿病患者的有效性和安全性[J]. 華西醫學, 2009, 24(5): 1144-1146.
14. 　于學靜, 于萍, 史為伍, 等. 甘精胰島素聯合口服藥物治療2型糖尿病肥胖患者的臨床觀察[J]. 實用糖尿病雜志, 2010, 6(4): 51-52.

West China Medical Journal

2型糖尿病肥胖患者口服降糖藥失效啟用胰島素治療方案的探討

Abstract Full text Figures/Tables Video References Cited by

Format

Content