改用门冬胰岛素多次皮下注射治疗可改善基础胰岛素甘精胰岛素注射的糖尿病患者的血糖控制、血管损伤和治疗满意度。

Switching to multiple daily injection therapy with glulisine improves glycaemic control, vascular damage and treatment satisfaction in basal insulin glargine-injected diabetic patients.

机构信息

Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan.

出版信息

Diabetes Metab Res Rev. 2014 Nov;30(8):693-700. doi: 10.1002/dmrr.2537.

DOI:10.1002/dmrr.2537

PMID:24639403

Abstract

BACKGROUND

Basal and bolus insulin therapy is required for strict blood control in diabetic patients, which could lead to prevention of vascular complications in diabetes. However, the optimal combination regimen is not well established.

METHODS

Fifty-nine diabetic patients (49 type 1 and 10 type 2; 52.9 ± 13.3 years old) whose blood glucose levels were uncontrolled (HbA1c > 6.2%) by combination treatment of basal insulin glargine with multiple daily pre-meal injections of bolus short-acting insulin [aspart (n = 19), lispro (n = 37) and regular human insulin (n = 3)] for at least 8 weeks were enrolled in this study. We examined whether glycaemic control and vascular injury were improved by replacement of short-acting insulin with glulisine. Patient satisfaction was assessed with Diabetes Treatment Satisfaction Questionnaire.

RESULTS

Although bolus and basal insulin doses were almost unchanged before and after replacement therapy, switching to glulisine insulin for 24 weeks significantly decreased level of HbA1c , advanced glycation end products (AGEs), soluble receptor for AGEs (sRAGE), monocyte chemoattractant protein-1 (MCP-1) and urinary albumin excretion. In multiple stepwise regression analysis, change in MCP-1 values from baseline (ΔMCP-1) was a sole determinant of log urinary albumin excretion. ΔAGEs and ΔsRAGE were independently correlated with each other. The relationship between ΔMCP-1 and ΔsRAGE was marginally significant (p = 0.05). Replacement of short-acting insulin by glulisine significantly increased Diabetes Treatment Satisfaction Questionnaire scores.

CONCLUSIONS

Our present study suggests that combination therapy of glargine with multiple daily pre-meal injections of glulisine might show superior efficacy in controlling blood glucose, preventing vascular damage and improving treatment satisfaction in diabetic patients.

摘要

背景

糖尿病患者需要进行基础和餐时胰岛素治疗以严格控制血糖，从而预防糖尿病血管并发症。然而，最佳的联合治疗方案尚未确定。

方法

本研究纳入了 59 名血糖控制不佳（HbA1c>6.2%）的糖尿病患者（19 名 1 型糖尿病患者和 37 名 2 型糖尿病患者；52.9±13.3 岁），这些患者接受甘精胰岛素基础胰岛素联合多次餐前注射短效胰岛素（门冬胰岛素、赖脯胰岛素和人胰岛素常规）治疗至少 8 周。我们检测了用谷赖胰岛素替代短效胰岛素是否能改善血糖控制和血管损伤。采用糖尿病治疗满意度问卷评估患者的满意度。

结果

尽管在替换治疗前后，餐时和基础胰岛素剂量几乎没有变化，但将胰岛素替换为谷赖胰岛素 24 周后，HbA1c、晚期糖基化终产物（AGEs）、AGEs 可溶性受体（sRAGE）、单核细胞趋化蛋白-1（MCP-1）和尿白蛋白排泄率显著降低。在多元逐步回归分析中，基线时 MCP-1 值的变化（ΔMCP-1）是尿白蛋白排泄的唯一决定因素。ΔAGEs 和 ΔsRAGE 彼此独立相关。ΔMCP-1 与 ΔsRAGE 之间的关系具有统计学意义（p=0.05）。用谷赖胰岛素替代短效胰岛素显著提高了糖尿病治疗满意度问卷评分。