Aggarwal Ajay, Wadhwa Roopak
Senior Consultant, Department of Endocrinology, Fortis Hospital, Shalimar Bagh, New Delhi, India.
Consultant, Department of Endocrinology, Fortis Hospital, Shalimar Bagh, New Delhi, India.
J Clin Diagn Res. 2017 Jul;11(7):OC21-OC24. doi: 10.7860/JCDR/2017/27649.10214. Epub 2017 Jul 1.
Basal insulin is among the second line treatment options for Type 2 Diabetes Mellitus (T2DM). Efficacy and safety of basal insulin in patients of T2DM, uncontrolled with Oral Antidiabetic Agents (OAAs) remains understudied in the Indian setting.
To assess the efficacy and safety of insulin glargine in patients with T2DM who have uncontrolled glycaemic levels despite single or two OAAs therapy.
In this prospective, open label study, T2DM patients above 40 years of age, having inadequate glycaemic control [Glycosylated Haemoglobin (HbA1c) above 8% and/or fasting glucose level of 140 mg/dl and above] with single or two OAAs over three consecutive months were included. Dosing of insulin glargine was adjusted as per Fasting Blood Glucose (FBG) and Post Prandial Blood Glucose (PPBG) levels. Patients were followed for 12 weeks and data was analysed by comparing 12 week findings to baseline values.
In 40 cases included in final analysis, mean age was 56.35 ± 6.77 years, 52.5% were females and mean body mass index was 26.96 ± 4.59 kg/m. Compared to baseline, significant reduction in HbA1c, FBG and PPBG blood glucose (all p<0.05) was seen. HbA1c goal of < 7% was achieved in 37.5% cases. Systolic (p>0.05) and diastolic (p<0.05) blood pressures reduced at 12 weeks as compared to baseline. Increase in weight was modest with mean increase of 1.06 kg (p>0.05). Overall, 14 symptomatic hypoglycaemia events were observed with none being severe.
Short term administration of insulin glargine is effective in reducing glycaemia and is safe with lower rates of severe hypoglycaemia. It can be considered in patients with uncontrolled T2DM on mono- or two- OAAs treatment.
基础胰岛素是2型糖尿病(T2DM)二线治疗方案之一。在印度,对于口服抗糖尿病药物(OAA)治疗效果不佳的T2DM患者,基础胰岛素的疗效和安全性仍未得到充分研究。
评估甘精胰岛素对单药或两药治疗后血糖仍未得到有效控制的T2DM患者的疗效和安全性。
本前瞻性、开放标签研究纳入了年龄在40岁以上、连续三个月单药或联合两药OAA治疗后血糖控制不佳(糖化血红蛋白(HbA1c)高于8%和/或空腹血糖水平在140mg/dl及以上)的T2DM患者。根据空腹血糖(FBG)和餐后血糖(PPBG)水平调整甘精胰岛素剂量。对患者进行12周的随访,并通过比较12周的结果与基线值来分析数据。
最终分析纳入的40例患者中,平均年龄为56.35±6.77岁,52.5%为女性,平均体重指数为26.96±4.59kg/m²。与基线相比,HbA1c、FBG和PPBG均显著降低(p均<0.05)。37.5%的患者HbA1c目标达到<7%。与基线相比,12周时收缩压(p>0.05)和舒张压(p<0.05)降低。体重平均增加1.06kg,增加幅度较小(p>0.05)。总体而言,共观察到14次有症状的低血糖事件,均不严重。
短期使用甘精胰岛素可有效降低血糖,安全性良好,严重低血糖发生率较低。对于单药或两药OAA治疗后血糖控制不佳的T2DM患者,可考虑使用甘精胰岛素。