强化胰岛素治疗联合二甲双胍可降低 2 型糖尿病患者的血糖变异性和夜间低血糖发生率。
Intensive insulin therapy combined with metformin is associated with reduction in both glucose variability and nocturnal hypoglycaemia in patients with type 2 diabetes.
机构信息
Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of Chinese Ministry of Health, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
出版信息
Diabetes Metab Res Rev. 2017 Oct;33(7). doi: 10.1002/dmrr.2913. Epub 2017 Jul 13.
BACKGROUND
The effect on glucose variability in patients with intensive insulin therapy has not been fully understood. This observational study investigated the different glucose variability and hypoglycaemia patterns in type 2 diabetes patients treated with continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) with or without metformin administration.
METHODS
During hospitalization, a total of 501 patients with poor glycaemic control and in initial treatment with either CSII alone (n = 187), CSII + Metformin (n = 81), MDI alone (n = 146), or MDI + Metformin (n = 87) were involved in the final analysis. Data obtained from continuous glucose monitoring were used to assess blood glucose fluctuation and nocturnal hypoglycaemia.
RESULTS
Among the 4 groups, no difference was found in mean blood glucose levels. Results in parameters reflecting glucose fluctuation: continuous overlapping net glycaemic action in CSII + Metformin and mean amplitude of glycaemic excursions in MDI + Metformin were significantly lower than those in either CSII alone or MDI alone, respectively, even after adjustment (P = .031 and .006). Frequency of nocturnal hypoglycaemia was significantly decreased in CSII + Metformin as compared with CSII alone (0.6% vs 1.8%) and in MDI + Metformin as compared with MDI alone (1.6% vs 2.3%), with the highest frequency observed in MDI alone and the lowest in CSII + Metformin (all between group P < .001). Consistent results were obtained in between-group comparisons for hypoglycaemia duration. Subgroup analysis matched with baseline body mass index, and glycated haemoglobin and fasting blood glucose further confirmed these findings.
CONCLUSION
Metformin added to initial CSII or MDI therapy is associated with a reduction in both glucose fluctuation and nocturnal hypoglycaemic risk in patients with type 2 diabetes.
背景
强化胰岛素治疗对血糖变异性的影响尚未完全阐明。本观察性研究旨在探讨接受持续皮下胰岛素输注（CSII）或多次皮下胰岛素注射（MDI）联合或不联合二甲双胍治疗的 2 型糖尿病患者的不同血糖变异性和低血糖模式。
方法
在住院期间，共有 501 名血糖控制不佳且初始接受 CSII 单药治疗（n=187）、CSII+二甲双胍（n=81）、MDI 单药治疗（n=146）或 MDI+二甲双胍（n=87）治疗的患者纳入最终分析。使用连续血糖监测获得的数据评估血糖波动和夜间低血糖情况。
结果
在 4 组患者中，平均血糖水平无差异。反映血糖波动的参数结果：CSII+二甲双胍的连续重叠净血糖作用和 MDI+二甲双胍的血糖波动幅度的平均值均明显低于 CSII 单药或 MDI 单药组，即使在调整后（P=0.031 和 P=0.006）。与 CSII 单药组相比，CSII+二甲双胍组夜间低血糖的发生频率明显降低（0.6% vs 1.8%），与 MDI 单药组相比，MDI+二甲双胍组夜间低血糖的发生频率明显降低（1.6% vs 2.3%），其中 MDI 单药组的发生频率最高，CSII+二甲双胍组的发生频率最低（组间比较均 P<0.001）。在低血糖持续时间方面，组间比较也得到了一致的结果。与基线体重指数、糖化血红蛋白和空腹血糖相匹配的亚组分析进一步证实了这些发现。
结论
在 2 型糖尿病患者中，初始 CSII 或 MDI 治疗中添加二甲双胍可降低血糖波动和夜间低血糖风险。
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