地特胰岛素与门冬胰岛素30起始治疗老年2型糖尿病伴轻度认知障碍患者的疗效比较

目的比较地特胰岛素与门冬胰岛素30起始治疗老年2型糖尿病伴轻度认知障碍(mild cognitive impairment,MCI)患者的有效性、安全性及对认知功能的影响。方法采用随机数字表法将100例老年2型糖尿病伴MCI患者分为地特胰岛素组和门冬胰岛素30组,每组50例。地特胰岛素组继续口服降糖药治疗,予地特胰岛素睡前注射;门冬胰岛素30组停用口服降糖药,予门冬胰岛素30早餐前和晚餐前皮下注射。治疗24周,观察空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)、胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、血压、体重、体重指数(BMI)及蒙特利尔认知评估(MoCA)量表评分的变化,并记录血糖达标、低血糖及痴呆发生情况。结果两组治疗后FPG、2hPG、HbA1c、LDL-C均显著降低(P<0.05),且地特胰岛素组2hPG、HbA1c降低程度大于门冬胰岛素30组(P<0.05)。两组治疗前后TC、TG、血压、体重、BMI比较差异均无统计学意义(P>0.05)。地特胰岛素组血糖达标率高于门冬胰岛素30组(P<0.05)。两组患者治疗后低血糖发生少而轻微,不良反应发生率比较,差异无统计学意义(P>0.05),两组治疗前后MoCA量表评分比较,差异无统计学意义(P>0.05)。结论地特胰岛素与门冬胰岛素30起始治疗老年2型糖尿病伴MCI患者均安全、有效,可作为胰岛素起始治疗的首选用药。

Comparison of clinical effects of insulin detemir and insulin aspart 30 in initial treatment of type 2 diabetes mellitus in elderly patients with mild cognitive impairment

Objective To compare the efficacy and safety of insulin detemir and insulin aspart 30 in initial treatment of type 2 diabetes mellitus in elderly patients with mild cognitive impairment and their effects on cognitive function.Methods One hundred elderly patients with type 2 diabetes mellitus and mild cognitive impairment were randomly divided into insulin detemir group and insulin aspart 30 group by random number table method,with 50 cases in each group.The insulin detemir group continued to take oral hypoglycemic drugs plus injection of insulin detemir at bedtime.The oral hypoglycemic drugs were discontinued and subcutaneous injection of insulin aspart 30 was given to the insulin aspart 30 group before breakfast and dinner.After 24 weeks of treatment,the changes in the levels of fasting blood-glucose(FPG),2-hour postprandial blood-glucose(2hPG),glycosylated hemoglobin(HbA1c),total cholesterol(TC),triacylglycerol(TG),low density lipoprotein(LDL-C),blood pressure,body weight,body mass index(BMI),and Montreal Cognitive Assessment(MoCA)Scale scores were observed,and the blood glucose reaching target level,hypoglycemia and the occurrence of dementia were recorded.Results After treatment,the levels of FPG,2hPG,HbA1c and LDL-C were significantly lower than those before treatment in the two groups(P<0.05),and 2hPG,HbA1c in the insulin detemir group were better than those in the insulin aspart 30 group(P<0.05).There were no significant differences in the changes of TC,TG,blood pressure,body weight and BMI before and after treatment in the two groups(P>0.05).The rate of blood glucose control in the insulin detemir group was higher than that in the insulin aspart 30 group(P<0.05).Hypoglycemia occurred less and slightly in the two groups after treatment,and there was no significant difference in the incidence of adverse reations between the two group(P>0.05).There were no significant differences in MoCA scores between the two groups before and after treatment(P>0.05).Conclusion Both insulin detemir and insulin aspart 30 are safe and effective in the initial treatment of elderly patients with type 2 diabetes mellitus and mild cognitive impairment.They can be used as the first choice for the initial treatment of insulin.