Maiti Rituparna, Jaida Jyothirmai, Leander Pulukuri John Israel, Irfanuddin Mohammed, Ahmed Idris, Palani Anuradha
Department of Pharmacology, Prathima Institute of Medical Sciences, Nagunur Road, Karimnagar, Andhra Pradesh, India.
J Res Med Sci. 2012 Jul;17(7):642-8.
Type II diabetes mellitus (DM) increases the risk of cardiovascular disease. Treatment with insulin substantially reduces C - reactive protein (CRP) because of its anti-atherosclerotic action. This study was designed to explore and compare the cardio protective role of regular human insulin (RHI), aspart and lispro insulin in type II DM.
A randomized, open, parallel group, comparative clinical study was conducted on 90 patients of type II DM. After baseline clinical assessment and investigations, RHI was prescribed to 30 patients, aspart insulin to 30 patients and lispro insulin to another 30 patients for 12 weeks. The efficacy variables were change in blood pressure, glycemic control, lipid profile, serum potassium, high-sensitivity CRP (hsCRP) and UKPDS 10-year CHD risk scoring over 12 weeks. At the end of the study, the patients were followed up and changes in variables from baseline were analyzed by statistical tools.
Systolic blood pressure decreased significantly in aspart group (P = 0.008) whereas diastolic blood pressure was decreased significantly both in aspart (P < 0.001) and lispro group (P = 0.01). Fasting, postprandial blood glucose and HbA1c were decreased in all three groups significantly but change in aspart group was superior (P = 0.01). Triglyceride was significantly better controlled by lispro (P < 0.01) whereas aspart insulin was superior to decrease total cholesterol and LDL (P < 0.05). The extent of potassium loss was significantly more with RHI (P = 0.004) than others. CRP-lowering effect (P = 0.017) and decrease in UKPDS risk scoring (P = 0.019) in aspart and lispro group was superior to RHI group.
Short acting insulin analogues, especially aspart insulin have been found to have a better cardio protective role than RHI in type II DM.
2型糖尿病（DM）会增加心血管疾病风险。胰岛素治疗因其抗动脉粥样硬化作用可大幅降低C反应蛋白（CRP）水平。本研究旨在探讨并比较常规人胰岛素（RHI）、门冬胰岛素和赖脯胰岛素在2型糖尿病中的心脏保护作用。
对90例2型糖尿病患者进行了一项随机、开放、平行组比较临床研究。在进行基线临床评估和检查后，为30例患者开具RHI，30例患者开具门冬胰岛素，另外30例患者开具赖脯胰岛素，治疗12周。疗效变量包括12周内血压变化、血糖控制、血脂谱、血清钾、高敏CRP（hsCRP）以及英国前瞻性糖尿病研究（UKPDS）10年冠心病风险评分。研究结束时，对患者进行随访，并使用统计工具分析变量相对于基线的变化。
门冬胰岛素组收缩压显著降低（P = 0.008），而门冬胰岛素组（P < 0.001）和赖脯胰岛素组（P = 0.01）舒张压均显著降低。三组患者的空腹、餐后血糖及糖化血红蛋白（HbA1c）均显著降低，但门冬胰岛素组变化更优（P = 0.01）。赖脯胰岛素对甘油三酯的控制效果显著更好（P < 0.01），而门冬胰岛素在降低总胆固醇和低密度脂蛋白方面更具优势（P < 0.05）。RHI导致的钾流失程度显著高于其他药物（P = 0.004）。门冬胰岛素组和赖脯胰岛素组降低CRP的效果（P = 0.017）以及UKPDS风险评分的降低幅度（P = 0.019）均优于RHI组。
已发现速效胰岛素类似物，尤其是门冬胰岛素，在2型糖尿病中比RHI具有更好的心脏保护作用。
