Yki-Järvinen Hannele, Juurinen Leena, Alvarsson Michael, Bystedt Tord, Caldwell Ian, Davies Melanie, Lahdenperä Sanni, Nijpels Gil, Vähätalo Markku
University of Helsinki, Helsinki, Finland.
Diabetes Care. 2007 Jun;30(6):1364-9. doi: 10.2337/dc06-1357. Epub 2007 Mar 23.
Insulin is often postponed for years because initiation is time-consuming. We sought to compare initiation of insulin individually and in groups with respect to change in A1C and several other parameters in type 2 diabetic patients.
A randomized (1:1), multicenter, two-arm, parallel design study with a recruiting period of up to 14 weeks and a 24-week treatment period. Either in groups of 4-8 or individually, using the same personnel and education program, 121 insulin-naive type 2 diabetic patients with an A1C of 7.0-12.0% were randomized to initiate bedtime insulin glargine. The patients visited the treatment center before and at the time of insulin initiation and at 6, 12, and 24 weeks. Patients self-adjusted the insulin dose to achieve a fasting plasma glucose 4.0-5.5 mmol/l.
At 24 weeks, mean +/- SE A1C had decreased from 8.7 +/- 0.2 to 6.9 +/- 0.1% in those treated individually and from 8.8 +/- 0.2 to 6.8 +/- 0.1% in those in groups (not significant [NS]). Insulin doses averaged 62 +/- 5 IU and 56 +/- 5 IU at 24 weeks (NS), respectively. The frequency of hypoglycemia was similar. The total time (visits and phone calls) spent in initiating insulin in the patients in groups (2.2 +/- 0.1 h) was 48% less than in those treated individually (4.2 +/- 0.2 h). Diabetes treatment satisfaction improved significantly in both sets of patients.
Similar glycemic control and treatment satisfaction can be achieved by initiating insulin in groups and individually. Starting insulin in groups takes one-half as much time as individual initiation.
由于启动胰岛素治疗耗时较长，胰岛素治疗常常被推迟数年。我们试图比较2型糖尿病患者单独启动胰岛素治疗和分组启动胰岛素治疗在糖化血红蛋白（A1C）及其他几个参数变化方面的情况。
一项随机（1:1）、多中心、双臂、平行设计研究，招募期长达14周，治疗期为24周。121例A1C为7.0 - 12.0%且既往未使用过胰岛素的2型糖尿病患者，采用相同的工作人员和教育方案，随机分为4 - 8人一组或单独接受治疗，启动睡前甘精胰岛素治疗。患者在胰岛素启动前、启动时以及第6、12和24周时到治疗中心就诊。患者自行调整胰岛素剂量，以使空腹血糖达到4.0 - 5.5 mmol/l。
在24周时，单独治疗的患者平均±标准误A1C从8.7±0.2%降至6.9±0.1%，分组治疗的患者从8.8±0.2%降至6.8±0.1%（无显著差异[NS]）。24周时胰岛素剂量分别平均为62±5 IU和56±5 IU（无显著差异）。低血糖发生频率相似。分组患者启动胰岛素治疗所花费的总时间（就诊和电话咨询）为（2.2±0.1小时），比单独治疗的患者（4.2±0.2小时）少48%。两组患者的糖尿病治疗满意度均显著提高。
分组启动胰岛素治疗和单独启动胰岛素治疗均可实现相似的血糖控制和治疗满意度。分组启动胰岛素治疗所需时间仅为单独启动的一半。
