甘精胰岛素联合瑞格列奈治疗继发性磺脲类药物失效的2型糖尿病患者疗效观察

目的观察甘精胰岛素联合瑞格列奈治疗继发性磺脲类药物失效的2型糖尿病患者的疗效。方法选取继发性磺脲类药物失效患者56例,给予甘精胰岛素每日1次皮下注射,同时联合瑞格列奈口服,治疗3个月,观察患者空腹血糖、餐后2 h血糖、HbA1c、体质量及BMI变化。结果治疗3个月后与治疗前相比患者空腹血糖、餐后2 h血糖、HbA1c均明显下降(P<0.05),体质量、BMI无明显变化(P>0.05)。结论甘精胰岛素联合瑞格列奈治疗控制继发性磺脲类药物失效的2型糖尿病患者血糖疗效显著,低血糖发生率低,体质量无明显增加,依从性良好,方法简便,安全。     

甘精胰岛素联合短效胰岛素强化治疗2型糖尿病的疗效和安全性观察

目的探讨甘精胰岛素联合短效胰岛素强化治疗2型糖尿病患者的有效性和安全性。方法将2型糖尿病患者58名随机分为2组,各29例。对照组给予预混胰岛素皮下注射,观察组给予甘精胰岛素注射液、短效胰岛素皮下注射,分别治疗12周,观察空腹血糖、三餐后血糖、每日血糖波动差值、糖化血红蛋白(HbA1c)、低血糖发生率等指标。结果 2组治疗后空腹血糖均较治疗前明显下降。观察组在早餐及午餐后2 h的血糖控制方面显著优于对照组,但2组间晚餐后血糖无差异。观察组每日血糖波动明显小于对照组。观察组中低血糖发生率(6.9%)低于对照组(24.1%)。结论甘精胰岛素联合短效胰岛素强化治疗2型糖尿病疗效显著,能有效控制餐后血糖,减小每日血糖波动,低血糖发生率低,是一种安全、有效的治疗方法。     

甘精胰岛素联合瑞格列奈治疗老年2型糖尿病疗效观察

目的探讨甘精胰岛素联合瑞格列奈冶疗老年2型糖尿病的疗效。方法将40例老年2型糖尿病患者按随机数字表法分甘精组和预混组,每组20例。甘精组予3餐前口服瑞格列奈1～2mg;睡前皮下注射甘精胰岛素,起始剂量0.2U.kg-1.d-2,根据空腹血糖(FPG)的变化,每2～3d增减1～3U。预混组每日早晚饭前30min皮下注射预混基因重组人胰岛素,起始剂量0.4U.kg-1.d-1,根据空腹及餐后血糖的变化调整剂量。2组均治疗12周为1个疗程。对2组治疗前后的FPG、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、低血糖发生率及全天7个时点血糖(3餐前+3餐后2h+睡前)水平的标准差(SDBG)进行比较。结果 2组治疗后FPG、2hPG及HbA1c较治疗前明显下降(均P<0.05)。2组FPG、2hPG及HbA1c比较差异均无统计学意义(均P>0.05)。甘精组治疗后低血糖发生率及SDBG均明显低于预混组(均P<0.05)。结论甘精胰岛素联合瑞格列奈治疗老年2型糖尿病能安全、平稳地降低血糖,改善糖代谢,且低血糖发生率低,血糖波动小,是治疗老年糖尿病患者理想的方案。     

甘精胰岛素联合瑞格列奈治疗2型糖尿病患者24h动态血糖变化

目的探讨20例继发性磺脲类失效（SFS）的2型糖尿病患者用甘精胰岛素治疗的效果。方法改用甘精胰岛素加瑞格列奈治疗3个月后与联合治疗前比较。结果24h总体血糖达标时段显著延长，24h平均血糖、空腹血糖、HbA1c均有显著下降。结论提示甘精胰岛素联合瑞格列奈能有效改善SFS的2型糖尿病24h血糖控制。     

基础胰岛素联合口服降糖药治疗2型糖尿病的临床疗效观察

目的评估基础胰岛素联合口服降糖药(OADs)用于治疗以预混胰岛素联合或不联合OADs为降糖方案的血糖控制欠佳的2型糖尿病(T2DM)患者的有效性及安全性。方法 32例预混胰岛素联合或不联合OADs治疗血糖控制欠佳的T2DM患者,停止正在使用的预混胰岛素,改用甘精胰岛素联合OADs治疗16周,比较受试者治疗前后糖化血红蛋白(HbA1c)、空腹血糖(FBG)、餐后血糖(PBG)、体质量指数(BMI)和胰岛素剂量,并记录低血糖事件发生情况。结果 32例患者均完成研究,经甘精胰岛素治疗16周后,受试者HbA1c、FBG、BMI均较治疗前明显下降(P0.01)。甘精胰岛素使用剂量较入组时预混胰岛素剂量显著减少(P0.01)。治疗期间有2例(6.2%)受试者发生低血糖事件2次,均为一般性低血糖。结论每日1次基础胰岛素能有效改善预混胰岛素加或不加OADs治疗失败的T2DM患者的糖代谢,并且不增加体质量。     

西格列汀或瑞格列奈联合甘精胰岛素治疗2型糖尿病的临床观察

目的比较西格列汀联合甘精胰岛素与瑞格列奈联合甘精胰岛素治疗2型糖尿病（T2DM）的疗效。方法将2011年1月-2012年12月80例服用2种口服降糖药（OAD）血糖控制不佳的T2DM患者,按就诊奇偶顺序分为观察组和对照组各40例,观察组采用西格列汀联合甘精胰岛素予以治疗,对照组应用瑞格列奈联合甘精胰岛素治疗,治疗12周,观察两组患者空腹血糖（FBG）、餐后2 h血糖（2hPG）、糖化血红蛋白（HbA1c）、体质量指数（BMI）等指标及胰岛素用量、低血糖发生情况。结果治疗后两组FBG、2hPG、HbA1c均较前下降（P〈0.05）;观察组与对照组HbA1c达标率分别为88.3%、87.8%,但观察组胰岛素用量比对照组减少12.1%,且BMI得到控制,低血糖发生率低。结论西格列汀联合甘精胰岛素治疗可有效控制血糖和体质量,减少低血糖事件,在同等HbA1c达标率下,所用的胰岛素剂量更少。     

甘精胰岛素联合阿卡波糖与预混胰岛素治疗初发2型糖尿病的疗效和安全性比较

【目的】比较甘精胰岛素联合阿卡波糖与预混胰岛素治疗新诊断的2型糖尿病患者的疗效和低血糖的风险。【方法】70例新诊断的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35例。甘精组每晚9时注射甘精胰岛素一次,三餐前口服阿卡波糖（拜糖平）;预混组每日早晚餐前分别注射诺和灵30R预混胰岛素,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FBG和餐后血糖都明显下降,但甘精组的下降幅度明显大于预混组,差异有显著性（P〈0.01）;到达终点时预混组剂量明显大于甘精组,差异有显著性（P〈0.05）;甘精组低血糖事件明显少于预混组（甘精组5例,预混组16例,χ2=4.285,P〈0.05）。【结论】初发2型糖尿病患者采用每日注射一次甘精胰岛素加口服阿卡波糖或每日2次注射预混胰岛素治疗,均能达到明显降糖效果。甘精胰岛素与预混胰岛素相比降低FBG的效果更好;低血糖的发生率低;胰岛素的用量少;每日一次皮下注射更方便,依从性更好。     

重组甘精胰岛素治疗2型糖尿病有效性及安全性临床观察

目的观察使用预混胰岛素治疗血糖控制不佳的2型糖尿病（T2DM）患者,改用重组甘精胰岛素治疗的有效性、安全性。方法采用自身对照的研究方式,共70例T2DM患者入组。所有患者停用预混胰岛素,启用基础胰岛素,治疗12周。观察血糖控制及低血糖发生情况。结果研究结束时受试者糖化血红蛋白（HbA1c）、空腹血糖（FBG）、餐后血糖（PBG）水平均较前明显下降,有9例（12.9%）受试者发生低血糖事件12次,均为一般性低血糖。结论重组甘精胰岛素较预混胰岛素在降低血糖、减少低血糖发生方面更具优势。     

甘精胰岛素联合口服降糖药治疗2型糖尿病

目的观察甘精胰岛素联合口服降糖药（OADs）治疗2型糖尿病的安全达标。方法选择OADs血糖控制不佳[糖化血糖蛋白（HbA1c）〉7．5％）]的2型糖尿病患者22例,采用甘精胰岛素联合OADs治疗,观察用药后空腹血糖（FBG）和HbA1c的变化。结果治疗后1、2、3、4、8、12周的FBG水平均较治疗前显著降低（P〈0．01）;治疗后12周HbA1c较治疗前显著下降（P〈0．01）,治疗12周后所有患者HbA1c〈6．5％;体重有轻微增加,差异无统计学意义;低血糖发生率低。结论甘精胰岛素能有效降低血糖,尤其对空腹血糖的作用大;不易出现低血糖,是一种较理想的作为基础胰岛素使用的药物。甘精胰岛素联合OADs治疗2型糖尿病可以安全达标。     

瑞格列奈联合甘精胰岛素治疗糖尿病肾病的疗效观察

【目的】探讨瑞格列奈联合甘精胰岛素治疗2型糖尿病肾病患者的疗效和安全性。【方法】48例糖尿病肾病(Mogensen分期Ⅲ～Ⅳ期)患者,随机分为2组。试验组24例,予瑞格列奈加甘精胰岛素联合治疗;对照组24例,予每日两次预混胰岛素治疗。疗程均为8周,观察治疗前后两组患者空腹血糖(FBG)、餐后2h血糖(2hBG)、糖化血红蛋白(HbA1c)、尿白蛋白排泄率(UAER)、血尿素氮(BUN)、肌酐(SCr)的变化及低血糖发生率的差异。【结果】试验组和对照组经治疗后FBG、2hBG、HbA1c、UAER均明显下降(P<0.01),但两组间比较差异无统计学意义(P>0.05);两组治疗前后BUN、SCr无显著差异(P>0.05)。试验组发生低血糖次数少于对照组(P<0.05)。【结论】瑞格列奈联合甘精胰岛素治疗糖尿病肾病可有效控制血糖,安全性和依从性良好。     

The human insulin analogue insulin lispro

Insulin lispro is a newly developed analogue of human insulin where the positions of the amino acids lysine and proline have been switched at the end of the B chain of the insulin molecule. Insulin lispro with lysine at position B28 and proline at position B29 has a weaker tendency for self-association than human insulin. This leads to three major differences in the pharmacokinetics: the action begins faster, has a higher peak and the duration is shorter than with human insulin. Thus, insulin lispro has a more precise action profile for the mealtime than human regular insulin. Insulin lispro is recommended to be injected within 15 min before the meal in contrast to 30–40 min for human insulin. In clinical trials with insulin lispro, the postprandial rise of blood glucose is smaller, the rate of hypoglycaemia is lower particularly at night-time, the need for snacks is smaller and the patient preference is better than with human insulin. The long-term control as reflected by an improvement in the HbA_]c level is better with insulin lispro than with human regular insulin, provided that an appropriate basal insulin regimen is used to take into account the shorter duration of action. A few patients have been described who have a severe resistance to human insulin but who have been succesfully treated with insulin lispro. Insulin lispro was designed to be used as a mealtime insulin, and it is a step forward in the treatment of diabetic patients using a basal-bolus insulin regimen.     

Inhaled insulin (pulmonary administered insulin)]

The first report according to Inhaled insulin came out in 1924. Recent clinical trials of inhaled insulin made a real story to insulin-treated diabetic patients. Among some companies, insulin preparation of Pfizer company group consists of dry insulin dispersed by aerosol into particles sufficiently fine to drift into the distal twigs of the respiratory tree. Skylar et al in 2001 reported a randomized proof-of-concept study of inhaled insulin in type 1 diabetes mellitus. The result showed the same efficacy to the same time injections of regular insulin. Other reports showed the efficacy of inhaled insulin comparable to that of lispro insulin and the same action to not only type 1 but also type 2 diabetic patients.     

Changes in insulin resistance with long-term insulin therapy

Thirteen newly diagnosed diabetic subjects, 5 with insulin-dependent diabetes mellitus (IDDM) and 8 with non-insulin-dependent diabetes mellitus, mean age 37.1 yr (range 25-64 yr), underwent glucose-clamp studies at diagnosis of diabetes at plasma glucose 200 mg/dl. Each subject was then treated twice daily with insulin for 6 mo with improvement in glycemic control, and the glucose-clamp studies repeated. Changes in glucose uptake at an insulin infusion rate of 1.0 mU X kg-1 X min-1 varied greatly from diagnosis to 6 mo. There were significant negative correlations between change in glucose uptake and diabetes type (r = -.78, P less than .002), C-peptide secretion (r = -.66, P less than .05), and age (r = -.62, P less than .05). At an insulin infusion rate of 10 mU X kg-1 X min-1 there was improvement in glucose uptake from diagnosis to 6 mo that did not reach statistical significance. During the steady-state periods of the glucose-clamp studies at diagnosis, growth hormone (GH) rose above basal, which reached statistical significance at the higher insulin infusion rate. This increase in GH was not apparent at the time of the glucose-clamp studies after insulin therapy. Our results indicate that in the clinical situation, only patients with IDDM can expect an improvement in their sensitivity to physiologic insulin levels with long-term insulin therapy. In all subjects, improvement in glycemic control leads to abolition of GH secretion in the presence of hyperglycemia.     

Comparison of an insulin analog,insulin aspart,and regular human insulin with no insulin in gestational diabetes mellitus

OBJECTIVE: To assess the short-term efficacy of insulin aspart in comparison with regular human insulin in women with gestational diabetes mellitus (GDM) during standardized meal tests. RESEARCH DESIGN AND METHODS: The study included 15 women with GDM who had inadequate diabetes control with diet alone. On 3 consecutive days, breakfast meal tests were performed-the first with no exogenous insulin and the other two after the injection of either regular insulin or insulin aspart. RESULTS: The peak insulin concentration was higher and the peak glucose and C-peptide concentrations were lower with both insulin preparations than with no exogenous insulin. Glucose areas under the curve above baseline were significantly lower with insulin aspart (180-min area, 7.1 mg. h. dl(-1); P = 0.018), but not with regular insulin (30.2 mg. h. dl(-1); P = 0.997), than with no insulin (29.4 mg. h. dl(-1)). CONCLUSIONS: This study demonstrates that effective postprandial glycemic control in women with GDM who required insulin was brought about by insulin aspart through higher insulin peak and lower demand on endogenous insulin secretion.     

Intensive insulin therapy with insulin lispro: a randomized trial of continuous subcutaneous insulin infusion versus multiple daily insulin injection

OBJECTIVE: To evaluate glycemic control, hypoglycemic events, and quality of life in patients treated with continuous subcutaneous insulin infusion (CSII) and multiple daily insulin injection (MDI), with insulin lispro as the principal insulin. RESEARCH DESIGN AND METHODS: This clinical trial enrolled 27 patients with type 1 diabetes. They were randomly assigned to CSII (n = 13) or MDI (n = 14) treatment regimens. Glycemic control (HbA(1c) level) was the primary outcome and was measured monthly for 9 months. Secondary outcomes were patient reports of hypoglycemic events (recorded monthly for 9 months) and quality of life assessed at 9 months using the Diabetes Quality of Life (DQOL) questionnaire. RESULTS: A significant decrease in HbA(1c) from baseline was shown for both groups. However, the overall treatment effect (CSII - MDI) for HbA(1c) was +0.08% (95% CI -0.23 to +0.39, P > 0.10). This was significantly less than the a priori limit of +/-0.5% (P = 0.004). The relative treatment effect ([CSII - MDI]/MDI) for the overall number of hypoglycemic events was +9% (95% CI -37 to +87, P > 0.10). There were no statistically significant differences between treatment groups for any of the DQOL subscales. CONCLUSIONS: No statistically significant differences in glycemic control, reported hypoglycemic events, or quality of life were found in this study. Furthermore, a clinically significant difference of more than +/-0.5% HbA(1c) between the two regimens can be confidently ruled out. We conclude that the choice of intensive insulin therapy should be a matter of patient preference, consistent with lifestyle.     

Human insulin

Human insulin may be advantageous for certain subsets of patients, such as those with gestational diabetes and those who need insulin only during stress or surgery. To date, there is no evidence to support the use of human insulin in diabetics who are doing well on older insulin preparations.