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目的观察睡前注射一次中效胰岛素治疗2型糖尿病的效果,监测低血糖的风险及不良反应的发生情况,了解此治疗方案的疗效及安全性。方法选择本社区42例口服降糖药物而血糖控制不达标的2型糖尿病患者,在口服降糖药的基础上,按自愿的原则分为两组,中效胰岛素(NPH)组(18例):原有的口服药物不变,睡前加用中效胰岛素皮下注射治疗;口服药物组(24例):采用增加口服药物剂量方法 ,逐步增加降糖药物的剂量,达到最大范围。以两组空腹血糖(FBG)均达到≤7.0 mmol/L为目标,共治疗6个月,观察两组血糖控制情况、低血糖事件及其他药物不良反应的发生情况。结果治疗后两组全天血糖谱及糖化血红蛋白(Hb A1c)均较基线水平有所下降,但NPH组下降比口服药物组更显著,两组下降幅度比较,差异具有统计学意义(P<0.05)。低血糖方面,两组各发生1例仅有症状的低血糖事件。不良反应方面,药物治疗组胃肠道反应较NPH组明显增高,差异具有统计学意义(8/24,0/18,P<0.01)。结论睡前注射一次中效胰岛素联合口服降糖药物方案治疗血糖控制不理想的2型糖尿病患者,疗效好,容易被患者接受,值得在社区推广。
Objective To observe the effect of once-before-injection of middle-acting insulin on type 2 diabetes mellitus, to monitor the risk of hypoglycemia and the incidence of adverse reactions and to understand the efficacy and safety of this treatment. Methods 42 patients with type 2 diabetes who did not meet the standard of glycemic control on the basis of oral hypoglycemic agents were divided into two groups based on the principle of voluntariness. The patients in the group of moderate-effect insulin (NPH) (n = 18) : The original oral drug unchanged, bedtime plus medium-acting insulin subcutaneous injection therapy; oral drug group (24 cases): increase the dose of oral drugs, and gradually increase the dose of hypoglycemic drugs to reach the maximum. A total of 6 months were included in the study. The incidence of hypoglycaemia and other adverse drug reactions were observed in two groups of patients with fasting blood glucose (FBG) ≤7.0 mmol / L. Results After treatment, the levels of blood glucose and HbA1c in the two groups decreased from the baseline levels, but the decline in NPH group was more significant than that in oral drug group. There was significant difference between the two groups in decreasing amplitude (P <0.05 ). In hypoglycemia, only one symptom of hypoglycemia occurred in both groups. Adverse reactions, gastrointestinal reactions in the drug treatment group was significantly higher than NPH group, the difference was statistically significant (8 / 24,0 / 18, P <0.01). Conclusions Bedtime injection of a combination of middle-acting insulin and oral hypoglycemic drugs for type 2 diabetes with unsatisfactory glycemic control is effective and easy to be accepted by patients and is worth promoting in the community.