超重或肥胖2型糖尿病大剂量胰岛素转非胰岛素方案的临床研究

发布时间：2018-06-15 00:54

  本文选题：2型糖尿病 + 超重/肥胖　； 参考：《重庆医科大学》2015年硕士论文

【摘要】：目的：评估超重或肥胖2型糖尿病患者以大剂量胰岛素为基础的方案转为非胰岛素方案治疗的安全性和有效性。方法：2013年10月至2014年9月于重庆医科大学附属第二医院就诊、病程三年以上、超重或肥胖的2型糖尿病患者80例,平均年龄63岁,糖化血红蛋白(HbAlc)7.0-10.0%,体重指数(BMI)25kg/m2,胰岛素或胰岛素类似物的用量40IU/日,随机分为非胰岛素治疗和持续胰岛素治疗2组,观察24周,比较2组的HbAlc、空腹血糖、餐后血糖、体重变化、BMI、HbAlc达标率、低血糖事件发生率等,所有数据采用EXCEL软件收集整理,并应用SPSS18.0软件进行分析。结果：排除依从性差、未按时随访病例,69例2型糖尿病患者纳入最终分析,两组基线时各项指标没有显著性差异。随访12周后非胰岛素组的腰围、臀围、BMI均小于胰岛素组,有统计学意义(P0.05)；随访24周后,除了腰、臀围及BMI外,两组间体重的差异也有统计学意义(P0.05)。非胰岛素组患者随访12周、24周后,与基线相比其体重、BMI、腰围、臀围、空腹血糖、甘油三酯均有所下降,其差异有统计学意义(P0.05),且在24周时患者的餐后血糖也低于基线,差异有统计学意义(P0.05)。最后,非胰岛素组和胰岛素组患者在入组时(24周时)的HbA1c达标率分别为29.03%(38.71%)、28.95%(34.21%)；两组患者的低血糖事件发生概率也有明显差异,非胰岛素组不发生或仅有一次低血糖事件的概率分别为58.06%、25.81%,共约83.87%,而胰岛素组在低血糖事件1X5或X≥5(X为低血糖事件发生次数)的概率分别为23.68%、18.42%,共约42.10%。结论：通过本研究发现,非胰岛素组患者的体重、BMI、腰、臀围以及甘油三酯呈明显下降趋势,而该组患者低血糖事件发生率也相对更低,这些指标均与心血管事件密切相关,并向着有利的方向发展,故考虑超重或肥胖2型糖尿病患者有望将大剂量胰岛素转为非胰岛素治疗方案,且有可能对患者的心血管安全有着深远的影响。
[Abstract]:Objective: to evaluate the safety and efficacy of high-dose insulin-based regimen to non-insulin regimen in overweight or obese type 2 diabetic patients. Methods: from October 2013 to September 2014, 80 patients with type 2 diabetes mellitus with the course of more than three years and overweight or obese were enrolled in the second affiliated Hospital of Chongqing Medical University, with an average age of 63 years. Hemoglobin glycosylated hemoglobin (HbAlc) 7.0-10.0, body mass index (BMI) = 25kg / m2, insulin or insulin analogue dosage (40 IUU / d) were randomly divided into two groups: non-insulin treatment group and continuous insulin treatment group. The two groups were observed for 24 weeks, and compared with two groups: HbAlc, fasting blood glucose, postprandial blood glucose. All the data were collected by excel software and analyzed by SPSS 18.0 software. Results: excluding poor compliance 69 patients with type 2 diabetes were included in the final analysis without timely follow-up. There was no significant difference between the two groups at baseline. After 12 weeks follow-up, the waist circumference and hip circumference BMI of the non-insulin group were all lower than that of the insulin group (P 0.05), and after 24 weeks follow-up, there were significant differences in body weight between the two groups in addition to waist, hip circumference and BMI. After 12 weeks and 24 weeks follow-up, the body weight, waist circumference, hip circumference, fasting blood glucose and triglyceride in the non-insulin group were all decreased, and the postprandial blood glucose was lower than the baseline at 24 weeks. The difference was statistically significant (P 0.05). Finally, the HbA1c standard rate of non-insulin group and insulin group was 29.03 / 38.71and 28.9595 / 34.21, respectively. There was also a significant difference in the probability of hypoglycemic events between the two groups. In the non-insulin group, the probability of no or only one hypoglycemia event was 58.06 or 25.81, which was about 83.87, while in the insulin group the probability of hypoglycemic event occurred at 1X5 or X 鈮，

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