Gill Geoffrey V, Gebrekidan Atakilt, English Patrick J, Tesfaye Solomon
Liverpool School of Tropical Medicine, Liverpool, UK.
Trop Doct. 2009 Jan;39(1):3-5. doi: 10.1258/td.2008.080032.
In the resource-poor areas of the tropics, diabetic patients requiring insulin are often treated with once-daily injections of intermediate-acting insulin. Glycaemic control on this regime is usually poor. We trialled a simple change to twice-daily insulin (same total daily dose, two-thirds given in morning, and one-third in evening) in a group of 20 Ethiopian diabetic patients treated in this way. Nurse support and contact, and self-glucose monitoring were not available. After three months, the haemoglobin Alc (HbAlc) had improved from 10.5 +/- 1.8 to 8.0 +/- 1.5% (P < 0.001). No improvement occurred in the 20 control patients who remained on once-daily insulin. Among the twice-daily insulin group there was a small increase in weight and mild hypoglycaemic episodes. However, all patients were very satisfied and wished to continue the new system. We conclude that a simple change from once- to twice-daily insulin, without monitoring or support, can lead to a significant improvement in the overall glycaemic control, and is suitable for resource-limited tropical countries.
在热带地区资源匮乏的地区，需要胰岛素治疗的糖尿病患者通常每日注射一次中效胰岛素。采用这种治疗方案时，血糖控制通常较差。我们对20名接受这种治疗方式的埃塞俄比亚糖尿病患者进行了一项简单的改变，即改为每日注射两次胰岛素（每日总剂量相同，三分之二在早晨注射，三分之一在晚上注射）。患者无法获得护士的支持与联系，也没有自我血糖监测。三个月后，糖化血红蛋白（HbAlc）从10.5±1.8%改善至8.0±1.5%（P<0.001）。继续每日注射一次胰岛素的20名对照患者则没有改善。在每日注射两次胰岛素的患者组中，体重略有增加，出现了轻度低血糖发作。然而，所有患者都非常满意，并希望继续采用新的治疗方案。我们得出结论，在没有监测或支持的情况下，从每日一次胰岛素简单改为每日两次胰岛素，可显著改善整体血糖控制，且适用于资源有限的热带国家。
