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目的观察使用胰岛素类似物治疗初诊腹型肥胖2型糖尿病患者的疗效及安全性,并在出院后改用“一针一药”方案,直至停用胰岛素,随访治疗方案的变化。方法选取2007年3月至2010年11月符合纳入标准的40例糖尿病住院男性患者,随机分为2组,A组20例采用门冬胰岛素每日三餐前联合睡前1次甘精胰岛素注射;B组20例门冬胰岛素每日三餐前注射。2组均采用胰岛素强化治疗直至血糖控制达标,观察治疗前后空腹血糖(FBG)、餐后2小时血糖(2hPPG)、C肽、血糖达标时间和达标时胰岛素使用量,以及低血糖发生情况。出院后改为口服药配合晚间注射1次甘精胰岛素,每日胰岛素总量<20U时停用胰岛素,仅用口服药(非促泌剂)配合运动饮食治疗,观察至复用胰岛素时的持续时间。结果全部患者治疗后血糖水平显著下降,C肽水平显著增加,2组间比较差异无统计学意义(P均>0.05);A组血糖达标时间短,胰岛素用量少,低血糖发生率高。出院随访显示仅使用口服药物仍可在一定时间内良好控制血糖。结论初诊腹型肥胖的2型糖尿病患者使用胰岛素类似物强化治疗安全、有效。
Objective To observe the efficacy and safety of insulin analogues in the treatment of newly diagnosed abdominal obesity type 2 diabetes mellitus and to switch from “one dose to one drug” after discharge until the insulin is withdrawn and the follow-up treatment plan changes. Methods Forty diabetic inpatients who met the inclusion criteria from March 2007 to November 2010 were randomly divided into two groups. Group A (20 cases) received insulin aspart before daily three doses of insulin glargine ; Group B 20 cases of insulin aspart 3 daily before meals. Both groups were treated with insulin until glycemic control was achieved. Fasting blood glucose (FBG), postprandial blood glucose (2hPPG), C-peptide, glycemic control time and standard insulin consumption, and incidence of hypoglycemia were observed before and after treatment. After discharge from the hospital to oral medication with glargine injection 1 night, the daily total insulin <20U disable insulin, only oral (non-secretagogues) with exercise diet, to observe the continued use of insulin time. Results After treatment, the blood glucose level decreased significantly and the level of C-peptide increased significantly in both groups. There was no significant difference between the two groups (P> 0.05). The A group had short blood glucose time, less insulin dosage and high incidence of hypoglycemia. Discharge follow-up showed that oral medication alone can still control blood sugar well within a certain period of time. Conclusions The initial diagnosis of abdominal obesity in type 2 diabetic patients with insulin analogs intensive treatment is safe and effective.