甘精胰岛素联合瑞格列奈治疗2型糖尿病疗效观察

应用低精蛋白胰岛素(诺和灵30R)治疗2型糖尿病,因低血糖发生率高,常难以达到满意的治疗效果.甘精胰岛素是精蛋白锌胰岛素类似物,瑞格列奈类为餐时血糖调节剂,二者联合应用优势互补,使空腹血糖及餐后血糖达标率显著提高.     

甘精胰岛素联合瑞格列奈治疗2型糖尿病临床疗效评价

选取诊断为2型糖尿病并进行治疗的患者100例,按照随机对照原则,将其分为使用甘精胰岛素同瑞格列奈联合治疗的治疗组50例,使用预混胰岛素治疗的对照组50例。对两组的疗效进行统计分析。治疗组空腹血糖(6.21±0.52)mmol/L,餐后2h血糖(8.35±1.54)mmol/L,糖化血红蛋白(6.11±0.75)%。对照组空腹血糖(6.67±0.58)mmol/L,餐后2h血糖(10.48±2.71)mmol/L,糖化血红蛋白(7.19±0.67)%。两组对比,差异具有统计学意义(P<0.05)。治疗组有效率为90%(45/50),对照组为80%(40/50)。两组对比,差异具有统计学意义(P<0.05)。对于2型糖尿病使用甘精胰岛素同瑞格列奈联合的方法进行治疗,效果显著且安全性高,值得大力推广应用。     

甘精胰岛素联合瑞格列奈治疗2型糖尿病疗效评价及分析

选取接受治疗的132例2型糖尿病患者为研究对象,按照治疗方法的不同,分为观察组与对照组,每组66例。对照组接受胰岛素皮下注射治疗,观察组接受甘精胰岛素联合瑞格列奈治疗,在1个疗程后,比较两组的治疗效果。治疗前后,两组Hb A1c、2 h PG、FPG均有明显差异,具有统计学意义(P<0.05)。观察组Hb A1c与对照组具有明显差异,具有统计学意义(P<0.05)。在2 h PG、FPG指标上,两组没有明显的差异,无统计学意义(P>0.05)。观察组治疗总有效率为98.5%;明显高于对照组的88.3%。利用甘精胰岛素结合瑞格列奈治疗2型糖尿病,具有良好的治疗效果,可以有效降低胰岛素用量,降低血糖含量,值得临床推广应用。     

甘精胰岛素联合瑞格列奈治疗老年2型糖尿病的疗效观察

目的观察老年2型糖尿病(T2DM)病人甘精胰岛素联合瑞格列奈降糖治疗的效果。方法 60例T2DM患者随机分为甘精组和预混组,甘精组三餐前15 min口服瑞格列奈0.5～1.0 mg,晚10∶00皮下注射甘精胰岛素。预混组于早晚饭前30 min注射预混胰岛素,应用罗康全血糖仪,住院期间监测空腹、三餐后2 h、夜10∶00、夜3∶00指尖血糖,根据血糖调整胰岛素剂量。空腹血糖(FPG)<7.0 mmol/L,餐后2 h血糖(2 hPG)<10.0 mmol/L为达标。观察血糖达标时间、胰岛素用量、低血糖发生次数、发生人数;12周后的FPG、2 hPG、糖化血红蛋白(HbAlc)、体质量指数(BMI)。结果两组血糖控制均达标,预混组和甘精组12周后,FPG2、hPG、HbA1c组间差异无统计学意义(P>0.05),组内与治疗前相比差异有统计学意义(P<0.01)。两组血糖达标时间差异无统计学意义(P>0.05),甘精组BMI较治疗前无明显增加(P>0.05),预混组BMI较治疗前明显增加(P<0.05)。甘精组胰岛素日用量、低血糖发生人数显著低于预混组(P<0.01),差异有统计学意义。结论两种治疗方案对控制血糖都有效,但甘精胰岛素联合瑞格列奈降糖治疗方案能减少注射次数和胰岛素的日用量,减少低血糖风险,不增加体质指数,依从性好。     

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型糖尿病患者的临床效果分析

目的 探讨研究甘精胰岛素联合瑞格列奈治疗2型糖尿病患者的临床效果。方法 选取2020年3月至2021年3月于本院收治的2型糖尿病患者128例,根据其治疗方法差异性分为观察组和对照组各64例。对照组患者采取瑞格列奈进行治疗,观察组患者基于对照组用药基础上联合甘精胰岛素进行治疗,比较两组患者治疗效果。结果 观察组治疗有效率为93.75%,高于对照组的78.13%,差异有统计学意义(P<0.05);治疗后,观察组FBG、2 h PBG、HbA1c水平均低于对照组,差异有统计学意义(P<0.05);观察组FINS、2 h PCP、FCP、HOMA-β等指标均高于对照组,HOMA-IR低于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率为7.81%,与对照组的6.25%相比差异无统计学意义(P>0.05)。结论 甘精胰岛素联合瑞格列奈治疗2型糖尿病患者,不仅能有效提高其降糖效果,还能改善患者胰岛功能,且不良反应未见增加,值得临床上大力推广。     

瑞格列奈联合甘精胰岛素治疗老年人2型糖尿病疗效评价

目的:分析研究甘精胰岛素联合瑞格列奈治疗老年人2型糖尿病的临床效果。方法:随机选取我院内分泌科2014年1月~2015年10月接收的106例老年人2型糖尿病患者,按随机自愿原则分成对照组50例和观察组56例。对照组给予常规预混胰岛素每天2次注射治疗;观察组给予每天睡前1次甘精胰岛素联合餐前口服瑞格列奈治疗。观察两组4个月的临床血糖控制情况、Hb Alc、BMI指标及不良反应情况。结果:两组治疗前血糖及各项指标均无显著差异。但治疗后,两组血糖控制及Hb Alc均较前改善,以观察组改善明显;除观察组BMI与治疗前比较无差异,其他各指标均存在显著差异(P0.05)。结论:应用甘精胰岛素联合瑞格列奈治疗老年2型糖尿病临床疗效果显著,能有效降低和控制患者血糖水平,减少不良反应的发生。     

甘精胰岛素联合瑞格列奈治疗2型糖尿病的疗效及安全性

目的 分析2型糖尿病中应用甘精胰岛素联合瑞格列奈治疗的临床效果。方法 选取2018年7月至2019年6月郑州市第十人民医院收治的60例2型糖尿病患者为研究对象,按照随机数字表法分为两组,每组30例,对照组应用诺和灵治疗,观察组应用甘精胰岛素联合瑞格列奈治疗。比较分析观察组与对照组患者治疗前后的血糖水平、低血糖发生率及胰岛素用量、不良反应发生率等临床指标。结果 观察组治疗后餐后2 h血糖水平、糖化血红蛋白及空腹血糖水平显著低于对照组,差异有统计学意义(P 0. 05)。两组低血糖发生率、胰岛素用量比较差异有统计学意义(P 0. 05)。观察组不良反应发生率为6. 67%(2/30),对照组为13. 33%(4/30),差异未见统计学意义(P 0. 05)。结论 2型糖尿病中应用甘精胰岛素联合瑞格列奈治疗的临床效果理想,安全性高,可有效改善患者的血糖水平,提高预后效果。     

甘精胰岛素联合瑞格列奈治疗初诊2型糖尿病的研究

目的探讨甘精胰岛素联合瑞格列奈治疗初诊2型糖尿病的临床效果。方法将本院初诊2型糖尿病患者60例随机分为观察组和对照组,对照组给予中短效的预混胰岛素治疗,观察组给予甘精胰岛素联合瑞格列奈治疗,评估两组临床效果。结果治疗后两组患者FPG、2h PG、Hb Alc明显优于治疗前,两组比较差异均有统计学意义(P0.05)。治疗后观察组患者Hb Alc明显优于对照组,两组比较差异有统计学意义(P0.05)。两组均无明显的低血糖事件发生。结论甘精胰岛素联合瑞格列奈治疗初诊2型糖尿病的临床效果明确,值得应用。     

甘精胰岛素联合瑞格列奈与预混胰岛素治疗的疗效与安全性比较

目的:比较甘精胰岛素联合瑞格列奈或二甲双胍与预混胰岛素(精蛋白锌重组赖脯胰岛素25)治疗的疗效与安全性.方法:将96例2型糖尿病口服降糖药控制不能达标的患者随机分为两组.A组为甘精胰岛素联合瑞格列奈或二甲双胍;B组为精蛋白锌赖脯胰岛素25组;两组以空腹血糖<6.1 mmol/L,同时B组餐前血糖<6.7 mmol/L为目标;观察24周,观察血糖、血糖波动、胰岛素日用量、低血糖的发生率、糖化学红蛋白的达标率及体重变化等指标.结果:两组糖化血红蛋白达标相似无统计学的差异;而空腹血糖达标率、胰岛素日用量、夜间低血糖的发生率、体重增加均A组优于B组.结论:甘精胰岛素联合瑞格列奈或二甲双胍治疗口服降糖药物控制不佳的2型糖尿病患者较精蛋白锌赖脯胰岛素治疗控制血糖更平稳,低血糖发生率少,体重增加少且同样能有良好的糖化血红蛋白达标,且依从性好.     

地特胰岛素与甘精胰岛素治疗2型糖尿病患者的临床疗效比较

目的比较口服降糖药（OAD）控制不佳的2型糖尿病（T2DM）患者加用1天1次地特胰岛素或甘精胰岛素治疗后对血糖的影响。方法共入选40例T2DM患者,随机给予睡前注射地特胰岛素或甘精胰岛素治疗。治疗时间为12周,比较两组治疗前后空腹血糖（FPG）、糖化血红蛋白（HbA1c）、体质量的变化及低血糖的发生。结果治疗12周时与治疗前比较,地特胰岛素组和甘精胰岛素组的HbA1c和FPG均有明显下降（P〈0．01）,FPG分别由11．41mmol／L和11．36mmol／L降至6．31mmol／L和6．54mmol／L,HbA1c分别由8．75％和9．17％降至7．41％和7．76％;治疗前后两组间差异无统计学意义。治疗前后地特胰岛素组和甘精胰岛素组的体质量增加分别为（-1．30±1．82）kg和（2．20±2．84）kg（P〈0．05）。两组各发生1例低血糖,发生率均为5．0％。结论OAD治疗不佳的T2DM患者,联合地特胰岛素或甘精胰岛素治疗,具有相似的血糖控制,但地特胰岛素组体质量增加少。     

Dosing of insulin glargine in the treatment of type 2 diabetes

BACKGROUND: Type 2 diabetes is a progressive disease characterized by insulin resistance and declining beta-cell function, often leading to a requirement for insulin therapy to maintain good glycemic control and prevent diabetes-associated complications. Adequate insulin dosing is crucial to the achievement of good glycemic control with minimal hypoglycemia, and dose titration immediately following insulin initiation is needed to ensure its success. Insulin may be initiated as an add-on therapy to oral treatment using a single evening basal insulin dose and titrating according to fasting blood glucose (FBG) levels (with an ideal target of <5.5 mmol/L [<100 mg/dL] to achieve glycosylated hemoglobin [HbA1c] <7%). OBJECTIVE: This review investigated options for, and clinical efficacy of, titration algorithms of insulin glargine in type 2 diabetes. METHODS: Articles from peer-reviewed journals were identified through searches of MEDLINE (years: 2000-2006). Search terms included insulin glargine, titration, algorithm, and type 2 diabetes. Studies were assessed and included in this review if they provided information regarding the method of dose titration of insulin glargine used. RESULTS: A total of 12 studies were identified and included in this review. In the 24-week Treat-to-Target study, in which 756 patients were randomized to receive either insulin glargine or neutral protamine Hagedorn (NPH) insulin, once-daily using a simple titration regimen (titration of daily insulin dose by 0-2, 2, 4, or 6-8 IU if mean fasting plasma glucose over the 3 previous days was >or=5.6-<6.7, >or=6.7-<7.8, >or=7.8-<10.0 or >or=10 mmol/L [>or=100-<120, >or=120-<140, >or=140-<180, or >or=180 mg/dL], respectively, in the absence of plasma glucose <4.0 mmol/L [<72 mg/dL]) more patients reached HbA1c 相似文献   

甘精胰岛素联合门冬胰岛素对血糖控制不佳的2型糖尿病患者临床疗效分析

目的探讨甘精胰岛素联合门冬胰岛素治疗血糖控制不佳的2型糖尿病(T2DM)患者的临床疗效。方法将86例T2DM患者随机分为2组,每组43例。观察组给予甘精胰岛素联合门冬胰岛素,对照组给予精蛋白生物合成人胰岛素联合生物合成人胰岛素。比较治疗3个月后2组空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平的变化,以及血糖达标时间、体质量增加量、胰岛素日用量、血糖日波动量及低血糖发生率的差异。结果观察组FPG、2hPG、HbAlc水平的改善幅度大于对照组;观察组血糖达标时间、体质量增加量、血糖日波动量及低血糖发生率均显著小于对照组。结论对于血糖控制不佳的T2DM患者,甘精胰岛素与门冬胰岛素联合应用可理想控制血糖,减少体质量增加量,降低低血糖发生率,是安全而有效的胰岛素强化治疗方案。     

Patients with type 2 diabetes inadequately controlled on premixed insulin: effect of initiating insulin glargine plus oral antidiabetic agents on glycaemic control in daily practice

AIM: Premixed insulin regimens are commonly used for type 2 diabetes mellitus (T2DM) patients. However, there is limited information regarding next-step therapy options in cases where premixed insulin does not provide adequate glycaemic control. This 12-week observational study of everyday clinical practice evaluated the efficacy and safety of insulin glargine (glargine) plus oral antidiabetic drugs (OADs) in T2DM patients previously treated with premixed insulin. METHODS: Type 2 diabetes mellitus patients taking premixed insulin were identified from German clinics and were eligible to switch to glargine plus OADs at the physicians' and patients' discretion, as part of routine clinical practice. The study design and conduct was in accordance with German regulations. Fasting blood glucose (FBG), 2-h postprandial blood glucose (PPBG) and glycosylated haemoglobin (HbA(1c)) were measured at the start and after a 12-week observation period. RESULTS: A total of 5045 patients were followed-up and received glargine plus OADs. FBG [start to end-point: 9.9 +/- 2.7 to 6.9 +/- 1.5 mmol/l (178 +/- 48 to 124 +/- 26 mg/dl); p < or = 0.001], 2-h PPBG [10.8 +/- 2.8 to 7.8 +/- 1.5 mmol/l (195 +/- 50 to 140 +/- 27 mg/dl)] and HbA(1c) (8.3 +/- 1.2 to 7.2 +/- 0.8%; p < or = 0.001) improved significantly from start to end-point, respectively. A total of 48.9%, 38.4% and 73.9% of patients had FBG < 6.7 mmol/l (< 120 mg/dl), 2-h PPBG < 7.2 mmol/l (< 130 mg/dl) or HbA(1c) < 7.5%, respectively, after 12 weeks. Significant reductions in body weight were observed between the start and end of the observation period. A total of 71 adverse events were reported by 38 patients. Hypoglycaemia was the most common event (n = 16). CONCLUSIONS: This observational study shows that, in T2DM patients inadequately controlled with premixed insulin, switching therapy to glargine plus OADs is associated with significant improvements in FBG and HbA(1c), and is well tolerated in everyday clinical practice. Further intensification of insulin therapy, perhaps by adding one or more injections of prandial insulin, would help provide further improvements in glycaemic control in these patients.     

初诊2型糖尿病短期强化治疗后应用甘精胰岛素临床观察

目的 观察甘精胰岛素在初诊2型糖尿病短期强化治疗后的临床应用.方法 选择68例强化治疗后血糖控制不理想的新诊断2型糖尿病患者,将其随机分成两组,甘精胰岛素组(35例)每日1次皮下注射,预混胰岛素(诺和灵30R)组(33例)每日2次皮下注射.观察两组患者的血糖控制情况,12周后观察两组患者糖化血红蛋白及C肽水平变化.结果 两组患者血糖均明显下降,甘精胰岛素组空腹血糖下降幅度明显大于预混组(P<0.05);两组的胰岛功能均得到明显恢复,但差异无统计学意义(P＞0.05).甘精胰岛素组低血糖发生率明显低于对照组(P＜0.05),甘精胰岛素组的胰岛素用量及体质量增加值低于预混组(P＜0.05).结论 对短期强化治疗后新诊断2型糖尿病血糖控制不理想患者,应用甘精胰岛素或预混胰岛素进行治疗,均能达到明显的降糖效果,使胰岛功能得到明显恢复.其中甘精胰岛素降低空腹血糖效果更好,胰岛素用量较少,夜间低血糖发生率低,应用方便、安全、有效,患者依从性好,是值得临床应用推广.     

甘精胰岛素控制危重患者血糖的疗效观察

目的观察用甘精胰岛素调控重症监护病房患者的血糖水平,以探讨其对预后的影响。方法选择重症监护病房患者194例,根据胰岛素种类和目标血糖的不同,分为甘精胰岛素组1(n=48例)和常规胰岛素组1(n=46例),目标血糖为6.1~8.3 mmol/L;甘精胰岛素组2(n=49例)和常规胰岛素组2(n=51例),目标血糖为4.4~6.1 mmol/L。比较两组患者低血糖的发生和各项预后指标的差异。结果当目标血糖相同,甘精胰岛素组与常规胰岛素组的感染发生率、住院时间和ICU滞留时间、住院费用、住院病死率均无显著差异(P>0.05)。但目标血糖6.1~8.3 mmol/L时常规胰岛素组有4例(8.7%)患者并发了低血糖,甘精胰岛素组无低血糖发生,两组间有显著性差异(P<0.01);目标血糖4.4~6.1 mmol/L时常规胰岛素组有8例(15.7%)患者并发了低血糖,甘精胰岛素组1例(2%),两组间有显著性差异(P<0.01)。结论甘精胰岛素控制血糖对危重患者预后影响与常规胰岛素相仿,但甘精胰岛素能显著降低低血糖的发生率。     

甘精胰岛素联合二甲双胍治疗2型糖尿病患者的疗效评价

目的探讨甘精胰岛素联合二甲双胍治疗2型糖尿病的临床疗效。方法选择本院收治的2型糖尿病患者100例,其中观察组50例患者采用甘精胰岛素联合二甲双胍进行治疗,对照组50例患者仅口服二甲双胍,比较2组患者的治疗效果。结果治疗后,观察组患者的血糖达标时间、平均空腹血糖、夜间低血糖发生率等指标均明显优于对照组患者,差异有统计学意义(P<0.05);观察组患者的空腹血糖(FBG)、空腹2 h血糖(2hPG)、糖化血红蛋白(HbAlc)等指标的改善情况也明显优于对照组,差异有统计学意义(P<0.05)。结论采用甘精胰岛素联合二甲双胍治疗2型糖尿病疗效显著。     

甘精胰岛素和二甲双胍联合治疗对初诊2型糖尿病患者炎症因子的影响

目的 观察甘精胰岛素与二甲双胍联合治疗对初诊2型糖尿病(T2DM)患者炎症因子的影响.方法 对110例新诊断的T2DM患者进行甘精胰岛素(起始剂量10 U/d)与二甲双胍(0.5 g,每天3次)联合治疗(T2DM组),疗程12周.另入选100例同期进行健康体检的正常人群为正常对照组.观察2组研究对象基线血糖指标空腹血糖(FPG)、餐后2 h血糖(2 hPG)和糖化血红蛋白(HbA_1c)以及炎症因子C-反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)和白细胞介素-6(IL-6)的差异,并比较T2DM组治疗前后血糖指标和炎症因子的变化.结果 观察前T2DM组的血糖指标及炎症因子明显高于对照组(P均＜0.05),其他基础临床资料没有差异(P均＞0.05).经甘精胰岛素和二甲双胍联合治疗12周后,T2DM组的血糖指标明显改善,FPG:治疗前(14.8±3.9)mmoL/L,治疗后(6.6±2.1)mmol/L;2 hPG:治疗前(17.6±3.3)mmol/L,治疗后(8.3±1.2)mmoL/L;HbA1c:治疗前(9.6±2.7)%,治疗后(6.5±0.8)%(t值分别为7.40、8.37、3.98,P均＜0.01).炎症因子水平也显著下降,CRP:治疗前(8.8±2.5)mg/L,治疗后(5.5±1.4)mg/L;TNF-α:治疗前(2.9±0.6)ng/L,治疗后(1.6±0.2)ng/L;IL-6:治疗前(170.3±22.2)pg/L,治疗后(105.9±14.6)pg/L(t值分别为4.61、3.52、5.68,P均＜0.05).结论 甘精胰岛素与二甲双胍联合治疗可以改善初诊T2DM患者的糖代谢,降低患者炎症因子的水平.     

Reduced hypoglycemia risk with insulin glargine: a meta-analysis comparing insulin glargine with human NPH insulin in type 2 diabetes

OBJECTIVE: Insulin glargine (LANTUS) is a once-daily basal insulin analog with a smooth 24-h time-action profile that provides effective glycemic control with reduced hypoglycemia risk (particularly nocturnal) compared with NPH insulin in patients with type 2 diabetes. A recent "treat-to-target" study has shown that more patients on insulin glargine reached HbA(1c) levels < or =7.0% without confirmed nocturnal hypoglycemia compared with NPH insulin. We further assessed the risk for hypoglycemia in a meta-analysis of controlled trials of a similar design for insulin glargine versus once- or twice-daily NPH insulin in adults with type 2 diabetes. RESEARCH DESIGN AND METHODS: All studies were 24-28 weeks long, except one 52-week study, for which interim 20-week data were used. RESULTS: Patient demographics were similar between the insulin glargine (n = 1,142) and NPH insulin (n = 1,162) groups. The proportion of patients achieving target HbA(1c) (< or =7.0%) was similar between insulin glargine-and NPH insulin-treated patients (30.8 and 32.1%, respectively). There was a consistent significant reduction of hypoglycemia risk associated with insulin glargine, compared with NPH insulin, in terms of overall symptomatic (11%; P = 0.0006) and nocturnal (26%; P < 0.0001) hypoglycemia. Most notably, the risk of severe hypoglycemia and severe nocturnal hypoglycemia were reduced with insulin glargine by 46% (P = 0.0442) and 59% (P = 0.0231), respectively. CONCLUSIONS: These results confirmed that insulin glargine given once daily reduces the risk of hypoglycemia compared with NPH insulin, which can facilitate more aggressive insulin treatment to a HbA(1c) target of < or =7.0% in patients with type 2 diabetes.