Maia Frederico F R, Melo Fabrício J, Araújo Isabella M, Araújo Levimar R
Departamento de Fisiologia, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG.
Arq Bras Endocrinol Metabol. 2007 Apr;51(3):426-30. doi: 10.1590/s0004-27302007000300010.
This study examined the impact of insulin glargine introduction in basal-bolus therapy in type 1 and type 2 diabetic patients with inadequate metabolic control (A1c > 6.9%) using previous NPH insulin regime. In this uncontrolled, retrospective study, 49 patients (28F/21M), average age 24.7 +/- 16.5, mean duration of DM 13.2 +/- 10.1 yrs., 93.1% DM1 patients, received insulin glargine plus mealtime rapid-acting insulin (lispro or aspart) followed by 90-day treatment. We analyzed mean total insulin dose, incidence of hypoglycemic events, convulsive crisis, hyperglycemic complications and A1c levels before and after three months of introduction of glargine therapy. A1c values were determined using the HPLC instrument, with a normal range of 4.3% to 6.9%. After switching to insulin glargine therapy, mean A1c dropped from 10.2 +/- 2.0 to 9.1 +/- 1.8%, with significant impact (p= 0.019). We observed a significant reduction of 0.11 U/kg/day in total insulin dose, dropped from 0.75 U/kg of NPH to 0.64 U/kg of glargine, with significant correlation (p< 0.05). The introduction of glargine therapy was coincident with a decrease of hypoglycemic crisis (p= 0.02), convulsive events due to hypoglycemia (severe hypoglycemic crisis) (p= 0.023) and ketosis (p= 0.001) switching MDI-treated patients with improvement of metabolic control (reduction of A1c levels). This therapy improved quality of life in these patients due to a significant reduction of hypoglycemic (including severe) events, ketosis episodes and total daily insulin dose, with important impact on health public services.
本研究探讨了在1型和2型糖尿病且代谢控制不佳（糖化血红蛋白＞6.9%）、使用既往中效胰岛素方案的患者中，引入甘精胰岛素进行基础-餐时胰岛素治疗的影响。在这项非对照回顾性研究中，49例患者（28例女性/21例男性），平均年龄24.7±16.5岁，糖尿病平均病程13.2±10.1年，93.1%为1型糖尿病患者，接受了甘精胰岛素加餐时速效胰岛素（赖脯胰岛素或门冬胰岛素）治疗，为期90天。我们分析了引入甘精胰岛素治疗三个月前后的平均总胰岛素剂量、低血糖事件发生率、惊厥性危机、高血糖并发症及糖化血红蛋白水平。糖化血红蛋白值使用高效液相色谱仪测定，正常范围为4.3%至6.9%。转换为甘精胰岛素治疗后，平均糖化血红蛋白从10.2±2.0降至9.1±1.8%，有显著影响（p = 0.019）。我们观察到总胰岛素剂量显著降低0.11 U/kg/天，从NPH的0.75 U/kg降至甘精胰岛素的0.64 U/kg，有显著相关性（p＜0.05）。引入甘精胰岛素治疗与低血糖危机减少（p = 0.02）、低血糖所致惊厥事件（严重低血糖危机）（p = 0.023）及酮症（p = 0.001）相关，转换为多次皮下注射治疗的患者代谢控制得到改善（糖化血红蛋白水平降低）。该治疗改善了这些患者的生活质量，因为低血糖（包括严重低血糖）事件、酮症发作及每日总胰岛素剂量显著减少，对公共卫生服务有重要影响。
