Wróbel Marta P, Wystrychowski Grzegorz, Psurek Anna, Szymborska-Kajanek Aleksandra, Strojek Krzysztof
Pol Arch Med Wewn. 2014;124(4):173-9. doi: 10.20452/pamw.2186. Epub 2014 Mar 14.
Hypoglycemia may have serious health consequences; therefore, it is important to expand knowledge on the factors that increase its prevalence.
The aim of the study was to evaluate the effect of the type of insulin-human vs. analogue-on the incidence of mild and severe hypoglycemia, body weight, and hemoglobin A1c (HbA1c) levels.
A total of 203 diabetic patients treated with intensive insulin therapy completed the questionnaire on hypoglycemia at baseline and at 3 and 6 months of the follow‑up. Body weight and HbA1c levels were measured at baseline and at 6 months. Incidence of mild and severe hypoglycemia, body weight, and HbA1c levels were compared between patients treated with short‑acting analogue and those treated with short‑acting human insulin (regardless of the type of long‑acting insulin used) and between patients receiving short- and long‑acting analogue insulin and those receiving short- and long‑acting human insulin. A multiple logistic regression analysis was used to find independent risk factors of severe hypoglycemia.
At baseline, mild hypoglycemia was more common in patients receiving insulin analogue. There were no differences between the subgroups in the incidence of severe hypoglycemia, HbA1c levels, and body weight. Male sex, older age, and the dose of long‑acting insulin were independently associated with a higher incidence of severe hypoglycemia. Type 2 diabetes and higher body weight were associated with a lower risk of severe hypoglycemia.
Our results suggest that use of insulin analogues may predispose to more frequent episodes of mild hypoglycemia, but it does not increase the incidence of severe hypoglycemia in patients on intensive insulin therapy. Insulin analogues are not different from human insulin in terms of the effects on HbA1c levels and body mass.
低血糖可能会产生严重的健康后果；因此，扩大对增加其患病率因素的认识很重要。
本研究的目的是评估胰岛素类型（人胰岛素与类似物胰岛素）对轻度和严重低血糖发生率、体重以及糖化血红蛋白（HbA1c）水平的影响。
共有203例接受强化胰岛素治疗的糖尿病患者在基线时以及随访的3个月和6个月时完成了关于低血糖的问卷调查。在基线时和6个月时测量体重和HbA1c水平。比较使用短效类似物胰岛素治疗的患者与使用短效人胰岛素治疗的患者（无论使用的长效胰岛素类型如何）之间，以及接受短效和长效类似物胰岛素治疗的患者与接受短效和长效人胰岛素治疗的患者之间的轻度和严重低血糖发生率、体重和HbA1c水平。采用多元逻辑回归分析来找出严重低血糖的独立危险因素。
在基线时，接受胰岛素类似物治疗的患者中轻度低血糖更为常见。各亚组在严重低血糖发生率、HbA1c水平和体重方面没有差异。男性、年龄较大以及长效胰岛素剂量与严重低血糖的较高发生率独立相关。2型糖尿病和较高体重与严重低血糖风险较低相关。
我们的结果表明，使用胰岛素类似物可能会使轻度低血糖发作更频繁，但在接受强化胰岛素治疗的患者中不会增加严重低血糖的发生率。胰岛素类似物在对HbA1c水平和体重的影响方面与人胰岛素没有差异。
