Suzuki Daisuke, Toyoda Masao, Kondo Masumi, Miyatake Han, Tanaka Eitaro, Sato Hiroki, Kuriyama Yusuke, Miyauchi Masaaki, Yamamoto Naoyuki, Kimura Moritsugu, Umezono Tomoya, Fukagawa Masafumi
Division of Nephrology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193 Japan.
Tokai J Exp Clin Med. 2012 Jul 20;37(2):35-40.
Attempts to achieve strict glycemic control with basal-bolus insulin therapy required increased dosages of neutral protamine Hagedorn (NPH) insulin. However, high dosage of NPH insulin often occurs nocturnal hypoglycemia. Insulin glargine can simulate normal basal insulin secretion with its flat time-action profiles. To confirm the efficacy of insulin glargine we investigated the type 2 diabetic patients on basal-bolus insulin therapy whose basal insulin was switched from NPH insulin to insulin glargine.
The Japanese 400 patients with type 2 diabetes on basal-bolus insulin therapy whose basal insulin was switched from NPH insulin to insulin glargine were followed-up. After the switching, the basal insulin was increased with reference to the self-monitoring of blood glucose results, with the aim of maintaining fasting blood sugar (FBS) level at 110 mg/dL, and simultaneously reducing the bolus insulin dosage to maintain the total daily insulin dosage.
We were able to lower FBS significantly with almost no serious hypoglycemia. HbA1c also improved significantly. The improvements in FBS and HbA1c levels did not require a significant increase in the total insulin dosage.
Our results suggest that basal insulin supplementation using insulin glargine is a useful method to control not only FBS but also HbA1c.
采用基础-餐时胰岛素疗法实现严格血糖控制时，需要增加中效胰岛素（NPH）的剂量。然而，高剂量的NPH胰岛素常引发夜间低血糖。甘精胰岛素能以其平稳的时间-作用曲线模拟正常基础胰岛素分泌。为证实甘精胰岛素的疗效，我们对基础-餐时胰岛素治疗的2型糖尿病患者进行了研究，这些患者的基础胰岛素由NPH胰岛素转换为甘精胰岛素。
对400例接受基础-餐时胰岛素治疗且基础胰岛素由NPH胰岛素转换为甘精胰岛素的日本2型糖尿病患者进行随访。转换后，根据自我血糖监测结果增加基础胰岛素剂量，目标是将空腹血糖（FBS）水平维持在110mg/dL，同时减少餐时胰岛素剂量以维持每日胰岛素总剂量。
我们能够显著降低FBS，且几乎没有严重低血糖发生。糖化血红蛋白（HbA1c）也显著改善。FBS和HbA1c水平的改善并不需要显著增加胰岛素总剂量。
我们的结果表明，使用甘精胰岛素补充基础胰岛素不仅是控制FBS，也是控制HbA1c的有效方法。
