Roth J, Milke B, Müller N, Zitterbart U, Rechtacek S, Rechtacek T, Kloos C, Wolf G, Müller U A
Department of Internal Medicine III, Jena University Hospital, Jena, Germany.
Practice for General Medicine, Kranichfeld, Germany.
Exp Clin Endocrinol Diabetes. 2015 Jun;123(6):368-70. doi: 10.1055/s-0035-1548796. Epub 2015 Jun 9.
To investigate the correctness of the recommendation for dose distribution in premixed insulin therapy, with two thirds of daily insulin dose before breakfast and one third of daily insulin dose before dinner.
The individual insulin dose distribution and metabolic control of people with Type 2 diabetes treated with premixed insulin therapy were studied in a cross sectional study involving 199 patients in a university outpatient department and 2 general practices in 2010.
All 199 patients were treated with premixed human insulin. The mean pre-breakfast dose was 57% (min. 32%, max. 83%) and the mean pre-dinner dose 43% (17-67%) of the total daily insulin. A pre-breakfast dose of exactly two thirds of total daily insulin was used by 6.5% (n=13), about two thirds, i. e., 60-70%, was injected by 27.6% of the patients. The diurnal insulin distribution<60%, 60% up to 70% and > 70% pre-breakfast insulin did not make any difference in HbA1c, which was 7.3% (56 mmol/mol) each.
The quite common recommendation in German and Austrian medical textbooks, that premixed insulin therapy should consists of a dose distribution with two thirds before breakfast and one third before dinner, is not observed in daily practice. Diurnal insulin dose distribution and HbA1c are not associated in this cohort. Novelty statement: The circadian insulin dose distribution of 2/3 before breakfast and 1/3 before dinner could not be confirmed for patients with diabetes type 2 and conventional insulin therapy. No correlation between metabolic control and insulin circadian insulin dose distribution was detected.
探讨预混胰岛素治疗中每日胰岛素剂量三分之二于早餐前、三分之一于晚餐前分配建议的正确性。
2010年在一所大学门诊部和两家普通诊所对199例患者进行横断面研究，以研究接受预混胰岛素治疗的2型糖尿病患者的个体胰岛素剂量分配和代谢控制情况。
199例患者均接受预混人胰岛素治疗。早餐前平均剂量占每日胰岛素总量的57%（最小值32%，最大值83%），晚餐前平均剂量占43%（17 - 67%）。6.5%（n = 13）的患者早餐前剂量恰好为每日胰岛素总量的三分之二，27.6%的患者注射剂量约为三分之二，即60 - 70%。早餐前胰岛素日间分布<60%、60%至70%和>70%时，糖化血红蛋白（HbA1c）无差异，均为7.3%（56 mmol/mol）。
德国和奥地利医学教科书中相当常见的建议，即预混胰岛素治疗应采用早餐前三分之二、晚餐前三分之一的剂量分配，在日常实践中未得到遵循。该队列中胰岛素日间剂量分配与HbA1c无关。新颖性声明：对于2型糖尿病患者和传统胰岛素治疗，无法证实早餐前胰岛素昼夜剂量分布为2/3、晚餐前为1/3。未检测到代谢控制与胰岛素昼夜剂量分布之间的相关性。
