[基础甘精胰岛素与中性鱼精蛋白锌胰岛素在1型糖尿病患者常规强化胰岛素治疗中的比较]

[Comparison between basal insulin glargine and NPH insulin in patients with diabetes type 1 on conventional intensive insulin therapy].

作者信息

Pesić Milica, Zivić Sasa, Radenković Sasa, Velojić Milena, Dimić Dragan, Antić Slobodan

机构信息

Klinicki centar, Klinika za endokrinologiju, dijabetes i bolesti metabolizma, Nis.

出版信息

Vojnosanit Pregl. 2007 Apr;64(4):247-52. doi: 10.2298/vsp0704247p.

DOI:10.2298/vsp0704247p

PMID:17580534

Abstract

BACKGROUND/AIM: Insulin glargine is a long-acting insulin analog that mimics normal basal insulin secretion without pronounced peaks. The aim of this study was to compare insulin glargine with isophane insulin (NPH insulin) for basal insulin supply in patients with type 1 diabetes.

METHODS

A total of 48 type 1 diabetics on long term conventional intensive insulin therapy (IT) were randomized to three different regimens of basal insulin substitution: 1. continuation of NPH insulin once daily at bedtime with more intensive selfmonitoring (n = 15); 2. NPH insulin twice daily (n = 15); 3. insulin glargine once daily (n = 18). Meal time insulin aspart was continued in all groups.

RESULTS

Fasting blood glucose (FBG) was lower in the glargine group (7.30+/-0.98 mmol/1) than in the twice daily NPH group (7.47+/-1.06 mmol/1), but without significant difference. FBG was significantly higher in the once daily NPH group (8.44+/-0.85 mmol/l; p < 0.05). HbAlc after 3 months did not change in the once daily NPH group, but decreased in the glargine group (from 7.72+/-0.86% to 6.87+/-0.50%), as well as in the twice daily NPH group (from 7.80+/-0.83% to 7.01+/-0.63%). Total daily insulin doses were similar in all groups but only in the glargine group there was an increase of basal and decrease of meal related insulin doses. The frequency of mild hypoglycemia was significantly lower in the glargine group (6.56+/-2.09) than in both NPH groups (9.0+/-1.65 in twice daily NPH group and 8.13+/-1.30 in other NPH group) (episodes/patients-month, p < 0.05).

CONCLUSION

Basal insulin supplementation in type 1 diabetes mellitus with either twice daily NPH insulin or glargine can result in similar glycemic control when combined with meal time insulin aspart. However, with glargine regimen FBG, HbAlc and frequency of hypoglycemic event are lower. These facts contribute to better patients satisfaction with insulin glargine versus NPH insulin in IIT in type 1 diabetics.

摘要

背景/目的：甘精胰岛素是一种长效胰岛素类似物，可模拟正常基础胰岛素分泌，且无明显峰值。本研究旨在比较甘精胰岛素与低精蛋白胰岛素（NPH胰岛素）在1型糖尿病患者基础胰岛素供应方面的效果。

方法

48例长期接受常规强化胰岛素治疗（IT）的1型糖尿病患者被随机分为三种不同的基础胰岛素替代方案：1. 继续每晚一次注射NPH胰岛素，并加强自我监测（n = 15）；2. 每日两次注射NPH胰岛素（n = 15）；3. 每日一次注射甘精胰岛素（n = 18）。所有组均继续使用餐时门冬胰岛素。

结果

甘精胰岛素组的空腹血糖（FBG）（7.30±0.98 mmol/L）低于每日两次注射NPH胰岛素组（7.47±1.06 mmol/L），但无显著差异。每日一次注射NPH胰岛素组的FBG显著更高（8.44±0.85 mmol/L；p < 0.05）。3个月后，每日一次注射NPH胰岛素组的糖化血红蛋白（HbAlc）未变化，而甘精胰岛素组（从7.72±0.86%降至6.87±0.50%）以及每日两次注射NPH胰岛素组（从7.80±0.83%降至7.01±0.63%）的HbAlc均有所下降。所有组的每日胰岛素总剂量相似，但仅甘精胰岛素组基础胰岛素剂量增加，餐时相关胰岛素剂量减少。甘精胰岛素组轻度低血糖的发生率（6.56±2.09）显著低于两个NPH胰岛素组（每日两次注射NPH胰岛素组为9.0±1.65，另一NPH胰岛素组为8.13±1.30）（事件/患者-月，p < 0.05）。