甘精胰岛素300 U/ml与100 U/ml治疗中国2型糖尿病患者疗效和安全性的比较

目的比较甘精胰岛素300 U/ml(Gla-300)与100 U/ml(Gla-100)治疗非胰岛素类降糖药血糖控制不佳中国T2DM患者的疗效和安全性。方法本研究为EDITION AP(NCT02855684)中国亚组分析,在这项开放标签、随机对照的临床试验中,非Ins类降糖药物血糖控制不佳的474例中国T2DM患者按2:1比例随机予Gla-300(n=315)或Gla-100(n=159)治疗,观察两组26周时的疗效和安全性指标。结果两组自基线至治疗26周时HbA1c降幅的最小二乘均值差为0.05%,达到非劣效性评估终点。26周治疗期间,Gla-300组发生至少1次重度和/或证实夜间低血糖患者比例低于Gla-100组(31.5%vs 42.0%,P=0.03)。两组其余疗效和安全性指标差异无统计学意义。结论Gla-300治疗26周降低HbA1c效果与Gla-100相似,发生夜间低血糖风险更低。     

Non-islet cell hypoglycemia

NICTH is a fairly uncommon disorder but has been well characterized and the molecular mechanisms involved have given insights into the IGF system, both normal and abnormal. NICTH has brought together the molecular biologists and endocrinologists in a classic cross cultural coordination to study the disorder from all angles and to further understand the disorder.     

甘精胰岛素联合西格列汀对首诊2型糖尿病血糖波动炎症因子及低血糖事件的影响

目的 探讨甘精胰岛素联合西格列汀对首诊2型糖尿病（T2DM）患者血糖波动、炎症因子及低血糖事件的影响。方法 选择2017年6月至2018年10月在无锡市第三人民医院接受治疗的124例首诊T2DM患者为研究对象,采用随机数字表法分为对照组与观察组,每组62例。对照组给予甘精胰岛素联合瑞格列奈治疗,观察组给予甘精胰岛素联合西格列汀治疗。比较两组患者空腹血糖（FBG）、餐后2 h血糖（2 h PBG）、糖化血红蛋白（HbA1c）、日内血糖平均波动幅度（MAGE）、日内血糖波动次数（NGE）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、C反应蛋白（CRP）、体质指数（BMI）,以及低血糖发生率和甘精胰岛素用量的差异。结果 观察组患者治疗后的MAGE为（2.53±1.19）mmol/L、NGE为（1.53±0.93）mmol/L,均低于对照组,差异有统计学意义（P<0.05）。两组患者治疗前与治疗后MAGE、NGE的差值进行比较,差异有统计学意义（P<0.05）。观察组患者治疗后的血清CRP水平为（2.76±1.03）mg/L、TNF-α为（19.83±8.41）ng/L、IL-6为（18.61±4.73）ng/L,均低于对照组,差异有统计学意义（P<0.05）。两组患者治疗前与治疗后血清CRP、TNF-α、IL-6差值进行比较,差异有统计学意义（P<0.05）。观察组患者治疗后的BMI为（23.24±2.83）kg/m²,对照组为（24.29±3.05）kg/m²,差异有统计学意义（P<0.05）。观察组患者低血糖发生率为1.60%、甘精胰岛素用量为（25.54±5.09）U/d,均低于对照组,差异有统计学意义（P<0.05）。结论 甘精胰岛素联合西格列汀能够减少血糖波动,减轻机体微炎症反应,减少低血糖发生率和甘精胰岛素用量。     

联络护士强化培训对冠心病合并糖尿病患者低血糖管理的影响

目的 探讨联络护士强化培训在冠心病合并糖尿病患者低血糖管理中的运用效果.方法 通过对心内科联络护士强化培训管理,对82例冠心病合并糖尿病患者实施低血糖管理,比较治疗前后患者低血糖情况及血糖 监测结果差异.结果 干预后,患者低血糖发生时机(Z=-0.756,P=0.450)、临床症状及诱因(Z=-1.105,P=0.269)差异无统计学意义;而低血糖发生率明显降低(x2=-2.000,P=0.046),低血糖监测频率(Z=-3.282,P=0.005)、应急处理(Z=-2.075,P=0.037)均较干预前改善.结论 对联络护士强化培训,可提高非糖尿病专科的患者低血糖风险防范意识,促进低血糖管理行为建立,减少低血糖发生.     

Frequency and awareness of hypoglycemia in patients with Type 2 Diabetes treated with two or more insulin injections in primary care outpatient clinics

AimsTo assess the frequency of hypoglycemia events, patient characteristics and the prevalence of impaired awareness of hypoglycemia (IAH) in patients with Type 2 Diabetes (T2D) using two or more insulin injections in primary care.MethodsCross-sectional study performed at 9 Primary Care Centers including review of electronic medical records and an on-site visit to patients using >2 insulin injections with suboptimal control. Episodes of severe hypoglycemia (SH) in the last 12 months were recorded. Non-severe hypoglycemia (NSH) was considered as self-monitoring blood glucose <70 mg/dl. IAH was evaluated and HbA_1c was obtained.Results157 subjects were included (age 68.4 + 10.7 years, 82 women, T2D duration 18.3 + 8.7 years). 57% used multiple daily injections. Total insulin was 66.9 + 43.4 units/day. The mean HbA_1c was 9.2 ± 1.4% (77 ± 12 mmol/mol) and only 13.4% had HbA_1c <8% (64 mmol/mol). The frequency of NSH was 0.74 ± 1.37 episodes/week. Only one patient had a SH the last 12 months. Around 10–12% of patients had IAH. In comparison with normal awareness, those with IAH had a longer duration of T2D (25.3 ± 11.6 vs. 16.1 ± 8.2 years, respectively, p < 0.01). In the multiple linear regression analysis, only the IAH score and the total insulin dose independently determined the NSH number.ConclusionsNSH/SH in patients with T2D treated with two or more insulin injections in primary care settings seems to be relatively common. Although hypoglycemia awareness is predominantly preserved, the presence of IAH should not be ignored as it increases the risk of hypoglycemia and constitutes an additional barrier to recognize and address this burden in T2D.     

长期服用呋塞米致低血糖症1例报道

呋塞米为强效利尿剂.长期服用利尿药可引起糖代谢异常.本文报道1例长期服用呋塞米导致低血糖症患者,提示应用呋塞米可致低血糖.