Jeffrey Kelson Diabetes Centre, Central Middlesex Hospital, London, UK.
Int J Clin Pract. 2010 Jul;64(8):1095-9. doi: 10.1111/j.1742-1241.2010.02347.x. Epub 2010 Mar 10.
To compare hypoglycaemic events, glycated haemoglobin (HbA1c) and changes in body weight in Muslim patients with Type 2 diabetes receiving Humalog Mix 50 and human Mixtard 30 twice daily during Ramadan fasting.
Data were collected from Muslim patients with Type 2 diabetes attending primary care practices in North-West London, who were on Mixtard 30 insulin twice daily before Ramadan. Group 1 had their evening insulin changed to Humalog Mix 50 (n = 26) 2 weeks before Ramadan, i.e. taking Mixtard 30 at predawn meal and Humalog Mix 50 at the sunset meal during Ramadan. As the major proportion of the daily caloric intake was consumed at the sunset meal, the rationale of switching the evening dose from human Mixtard 30 to Humalog Mix 50 was to provide more rapid-acting insulin that has shorter time of onset and peak time for the large evening meal to improve the postprandial glucose control without increasing the risk of hypoglycaemia. Group 2 continued on Mixtard 30 twice daily (n = 26). All patients received structured education about how to identify and manage hypoglycaemia during Ramadan.
Group 1 had a mean HbA1c reduction of 0.48% (p = 0.0001) before and after Ramadan, whereas group 2 had a mean HbA1c increase of 0.28% (p = 0.007). Group 1 was associated with a small reduction of 0.04 (p = 0.81) in the mean number of hypoglycaemic events during Ramadan compared with before Ramadan, whereas group 2 was associated with an increase of 0.15 (p = 0.43), although these differences between the groups were not statistically significant following adjustment for baseline factors [LSM difference between groups = 0.135, p = 0.36, 95% confidence limits (-0.16, 0.43)].
Changing to humalog Mix 50 during Ramadan resulted in improvement in glycaemic control without increasing the incidence of hypoglycaemia.
比较在斋月禁食期间，接受每日两次 Humalog Mix 50 和人混合胰岛素 30 治疗的 2 型糖尿病穆斯林患者的低血糖事件、糖化血红蛋白（HbA1c）和体重变化。
数据来自于在伦敦西北部的基层医疗机构就诊的 2 型糖尿病穆斯林患者，他们在斋月前每天两次接受人混合胰岛素 30 治疗。第 1 组患者在斋月前 2 周将晚上的胰岛素改为 Humalog Mix 50（n = 26），即清晨餐时服用人混合胰岛素 30，傍晚餐时服用 Humalog Mix 50。由于大部分日常热量摄入是在傍晚餐时摄入，因此将晚上的剂量从人混合胰岛素 30 改为 Humalog Mix 50 的理论依据是提供更快作用的胰岛素，其起效时间和峰值时间更短，以便在不增加低血糖风险的情况下改善餐后血糖控制。第 2 组继续每日两次接受人混合胰岛素 30 治疗（n = 26）。所有患者都接受了关于如何在斋月期间识别和管理低血糖的结构化教育。
第 1 组患者在斋月前后的平均 HbA1c 降低了 0.48%（p = 0.0001），而第 2 组患者的平均 HbA1c 升高了 0.28%（p = 0.007）。与斋月前相比，第 1 组患者在斋月期间的低血糖事件平均减少了 0.04（p = 0.81），而第 2 组患者的低血糖事件则增加了 0.15（p = 0.43），但这些组间差异在调整基线因素后没有统计学意义[组间 LSM 差异=0.135，p = 0.36，95%置信区间（-0.16，0.43）]。
在斋月期间改用 Humalog Mix 50 可改善血糖控制，而不会增加低血糖的发生率。
