Johansen Odd Erik, Vanberg Pål Johan, Kilhovd Bente Kvarv, Jørgensen Anders Palmstrøm
Medical Department, Asker and Baerum Hospital, RUD, Norway.
Vasc Health Risk Manag. 2009;5(1):121-8. Epub 2009 Apr 8.
The insulin analogs, glargine and detemir, are associated with reduced hypoglycemia incidence compared with NPH insulin. We assessed the impact of changing basal insulin from NPH to glargine or detemir in patients with type 1 diabetes mellitus who experienced severe hypoglycemia.
A retrospective chart review was conducted that included 73 (31 female) patients (mean age 48 years, diabetes duration 19 years) treated for 12 to 24 months with insulin glargine (n = 43) or detemir (n = 30).
There were no patients who withdrew from treatment due to side effects. The mean treatment duration in both groups was 18 months. Changing from NPH insulin was associated with a -0.3% (p = 0.036) reduction in HbA1c for glargine (baseline 8.8%) and -0.4% (p = 0.040) for detemir (baseline 8.3%) treated patients; insulin dosages increased, respectively by 4.1 (p = 0.045) and 4.3 units (p = 0.004) (mean values). Weight did not increase significantly and the 1-year rate of serious hypoglycemia was 0.25/person/year.
Switching from NPH-insulin to insulin detemir or glargine in type 1 diabetes mellitus patients with previous serious hypoglycemia was associated with a reduction in HbA1c. However, severe hypoglycemia was not completely eliminated, and few patients reached internationally accepted glycemic treatment goals.
We searched Medline, PubMed (with key search terms type 1 diabetes, NPH insulin, detemir, glargine and serious hypoglycemia), reference lists and databases of ongoing and completed trials (through July 2008) provided from the manufacturers of the drugs to identify relevant literature.
与中性鱼精蛋白锌胰岛素（NPH胰岛素）相比，胰岛素类似物甘精胰岛素和地特胰岛素与低血糖发生率降低相关。我们评估了1型糖尿病患者中，将基础胰岛素从NPH胰岛素转换为甘精胰岛素或地特胰岛素，对经历过严重低血糖的患者的影响。
进行了一项回顾性病历审查，纳入了73例（31例女性）患者（平均年龄48岁，糖尿病病程19年），这些患者接受甘精胰岛素（n = 43）或地特胰岛素（n = 30）治疗12至24个月。
没有患者因副作用退出治疗。两组的平均治疗时长均为18个月。对于接受甘精胰岛素治疗的患者（基线糖化血红蛋白为8.8%），从NPH胰岛素转换后糖化血红蛋白降低了-0.3%（p = 0.036）；对于接受地特胰岛素治疗的患者（基线糖化血红蛋白为8.3%），转换后糖化血红蛋白降低了-0.4%（p = 0.040）；胰岛素剂量分别平均增加了4.1单位（p = 0.045）和4.3单位（p = 0.004）。体重没有显著增加，严重低血糖的1年发生率为0.25/人/年。
在既往有严重低血糖的1型糖尿病患者中，从NPH胰岛素转换为地特胰岛素或甘精胰岛素与糖化血红蛋白降低相关。然而，严重低血糖并未完全消除，很少有患者达到国际认可的血糖治疗目标。
我们检索了医学期刊数据库、医学期刊全文数据库（使用关键词1型糖尿病、NPH胰岛素、地特胰岛素、甘精胰岛素和严重低血糖）、参考文献列表以及药物制造商提供的正在进行和已完成试验的数据库（截至2008年7月），以识别相关文献。
