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目的探讨阿卡波糖片联合精蛋白锌重组赖脯胰岛素混合注射液(25R)治疗口服降糖药物血糖控制不佳(失效)的老年2型糖尿病患者的疗效及安全性。方法选择口服降糖药物血糖控制不佳的老年2型糖尿病患者80例。随机分为治疗组和对照组各40例。治疗组每天餐时口服阿卡波糖片,早、晚餐前即刻皮下注射精蛋白锌重组赖脯胰岛素混合注射液(25R);对照组每天早、晚餐前30 min皮下注射精蛋白锌重组人胰岛素混合注射液。根据血糖水平,每3 d调整一次胰岛素剂量,以空腹血糖(FPG)<8.0 mmol.L-1,餐后血糖(2hPG)<10.0 mmol.L-1为治疗目标,共治疗12周,观察FPG、2hPG、糖化血红蛋白(HbA1c)水平,胰岛素用量及低血糖反应情况。结果治疗12周后,2组的全天血糖谱、HbA1c较治疗前显著下降(P<0.01);治疗组2hPG较对照组显著下降(P<0.05),治疗组胰岛素用量(28.3±6.40)U.d-1较对照组显著减少(35.70±5.80)U.d-1(P<0.01),低血糖反应发生1例(2.5%)明显低于对照组8例(20%)(P<0.05)。结论阿卡波糖片联合精蛋白锌重组赖脯胰岛素混合注射液(25R)为针对口服降糖药血糖控制不佳的老年2型糖尿病患者的一种较有效、安全的治疗方法。
Objective To investigate the efficacy and safety of acarbose plus protamine zinc mixed insulin lispro injection (25R) in the treatment of elderly type 2 diabetic patients with poor glycemic control of oral hypoglycemic drugs. Methods Eighty elderly patients with type 2 diabetes who were poorly controlled by oral hypoglycemic drugs were selected. Randomly divided into treatment group and control group of 40 cases. The patients in the treatment group were treated with acarbose daily at mealtime, and were given subcutaneous injection of protamine zinc mixed insulin lispro injection (25R) immediately before breakfast and before dinner. The control group was given subcutaneous injection of protamine zinc recombinant human insulin Mix the injection. According to the blood glucose level, the insulin dose was adjusted every 3 days. FPG <8.0 mmol.L-1 and postprandial blood glucose (2hPG) <10.0 mmol.L-1 were taken as the therapeutic targets for 12 weeks. FPG , 2hPG, HbA1c level, insulin dosage and hypoglycemic reaction. Results After treatment for 12 weeks, the levels of HbA1c and blood glucose in the two groups were significantly lower than those before treatment (P <0.01). The 2hPG in the treatment group was significantly lower than that in the control group (P <0.05), and the insulin dosage (28.3 ± 6.40) Ud 1 was significantly lower than that of the control group (35.70 ± 5.80) Ud-1 (P <0.01). The incidence of hypoglycemia was significantly lower in 1 patient (2.5%) than in the control group (8%, 20%) (P <0.05). Conclusions Acarbose combined with protamine zinc mixed insulin lispro injection (25R) is an effective and safe treatment for elderly type 2 diabetic patients with poor glycemic control by oral hypoglycemic agents.