Kadiri A, Al-Nakhi A, El-Ghazali S, Jabbar A, Al Arouj M, Akram J, Wyatt J, Assem A, Ristic S
Service d'Endocrinologie, Chu Ibn Sina Rabat, Morocco.
Diabetes Metab. 2001 Sep;27(4 Pt 1):482-6.
To compare insulin lispro with regular human insulin with respect to blood glucose control and frequency of hypoglycaemia in patients with type 1 diabetes who wished to fast during the month of Ramadan.
Insulin lispro or regular human insulin was given together with NPH insulin, twice daily before the morning and evening meals, for two weeks each in an open-label, randomised, cross-over design, and 64 patients completed the protocol. Blood glucose was self-monitored at fasting morning and evening, and 1-h and 2-h after the post-sunset meal on three consecutive days at the end of each treatment period.
The 2-h blood glucose excursion after the post-sunset meal was significantly (p=0.026) lower with insulin lispro (2.50 +/- 0.46 mmol/l) than with regular human insulin (3.47 +/- 0.49 mmol/l). Daily insulin doses did not differ between treatments but compliance with recommended time of injection was better with insulin lispro. Hypoglycaemia incidence (insulin lispro, 15 (23.4%) patients; regular human insulin 31 (48.4%) patients; p=0.004) and frequency (insulin lispro, 0.70 +/- 0.19; regular human insulin 2.25 +/- 0.36 episodes/patient/30 days; p<0.001) were lower with insulin lispro. Five (22.7%) of the episodes during insulin lispro occurred during the nocturnal period compared with 27 (36.5%) of the episodes while on regular human insulin.
Glycaemic control, measured by postprandial glycemic excursions, was improved and hypoglycaemia was significantly reduced with insulin lispro compared with regular human insulin. Patients with type 1 diabetes who insist on fasting during Ramadan may be better managed with insulin lispro.
比较赖脯胰岛素与常规人胰岛素在斋月期间希望禁食的1型糖尿病患者的血糖控制及低血糖发生频率方面的差异。
采用开放标签、随机、交叉设计，将赖脯胰岛素或常规人胰岛素与中性鱼精蛋白锌胰岛素（NPH胰岛素）联合使用，每天早晚餐前各给药一次，每种药物使用两周，64例患者完成了该方案。在每个治疗期结束时，连续三天于空腹晨、晚及日落后餐1小时和2小时进行自我血糖监测。
日落后餐2小时血糖波动，赖脯胰岛素组（2.50±0.46 mmol/L）显著低于常规人胰岛素组（3.47±0.49 mmol/L）（p=0.026）。不同治疗组的每日胰岛素剂量无差异，但赖脯胰岛素组注射时间的依从性更好。低血糖发生率（赖脯胰岛素组15例（23.4%）患者；常规人胰岛素组31例（48.4%）患者；p=0.004）和发生频率（赖脯胰岛素组0.70±0.19；常规人胰岛素组2.25±0.36次/患者/30天；p<0.001），赖脯胰岛素组均更低。赖脯胰岛素组低血糖发作有5次（22.7%）发生在夜间，而常规人胰岛素组为27次（36.5%）。
与常规人胰岛素相比，赖脯胰岛素可改善餐后血糖波动所衡量的血糖控制，并显著降低低血糖发生率。对于斋月期间坚持禁食的1型糖尿病患者，使用赖脯胰岛素可能管理效果更佳。
