Wu Yiming, Zhang Junqing, Li Ang
Department of Endocrinology, Peking University First Hospital, No. 8 Xishiku Street, Beijing, 100034, China.
Diabetes Ther. 2024 Dec;15(12):2515-2523. doi: 10.1007/s13300-024-01663-x. Epub 2024 Oct 26.
When switching from premixed insulin to insulin degludec/aspart (IDegAsp), IDegAsp usually starts at the same dose as the premixed insulin according to limited clinical experience or at a dose according to clinician discretion. The dose of insulin degludec used in the real world after switching has been poorly investigated.
A retrospective analysis was conducted on patients with type 2 diabetes who switched from premixed insulin to IDegAsp from October 2016 to December 2023. Repeated measures analysis of variance was used to compare changes in insulin dose, glycated hemoglobin (HbA1c), fasting blood glucose (FBG), and postprandial blood glucose (PBG) before and after switching.
Sixty-six patients with prior low-ratio premixed insulin and 22 with prior mid-ratio premixed insulin were included. Among the low-ratio insulin users, the total daily dose of insulin degludec (IDeg) decreased by 21.43% and 19.05% at 3 and 6 months, respectively, after switching, compared with prior basal insulin dose (both p < 0.001). Conversely, among mid-ratio insulin users, the IDeg daily dose increased by 10.71% and 32.14% at 3 and 6 months, respectively, after switching, compared with prior basal insulin dose (both p < 0.001). In all patients, HbA1c levels decreased by 0.70%, FBG decreased by 1.00 mmol/l, and PBG decreased by 1.61 mmol/l after 6 months of switching (all p < 0.05); the total daily insulin dose and injection frequency significantly decreased after switching (both p < 0.05); age and disease duration did not affect IDegAsp effects on HbA1c reduction.
In the setting of transition to IDegAsp from premixed insulin, the dose of basal insulin in the premixed formulation can be a valuable reference for adjusting insulin degludec dose. IDegAsp is superior to premixed insulin in blood glucose control with reduced total daily dose and injection frequency. IDegAsp could be the best choice for the management of diabetes in elderly patients.
根据有限的临床经验，从预混胰岛素转换为德谷胰岛素/门冬胰岛素（IDegAsp）时，IDegAsp通常起始剂量与预混胰岛素相同，或由临床医生酌情决定剂量。转换后在现实世界中使用的德谷胰岛素剂量尚未得到充分研究。
对2016年10月至2023年12月期间从预混胰岛素转换为IDegAsp的2型糖尿病患者进行回顾性分析。采用重复测量方差分析比较转换前后胰岛素剂量、糖化血红蛋白（HbA1c）、空腹血糖（FBG）和餐后血糖（PBG）的变化。
纳入66例之前使用低比例预混胰岛素的患者和22例之前使用中比例预混胰岛素的患者。在低比例胰岛素使用者中，转换后3个月和6个月时，德谷胰岛素（IDeg）的每日总剂量分别比之前的基础胰岛素剂量降低了21.43%和19.05%（均p＜0.001）。相反，在中比例胰岛素使用者中，转换后3个月和6个月时，IDeg的每日剂量分别比之前的基础胰岛素剂量增加了10.71%和32.14%（均p＜0.001）。在所有患者中，转换6个月后，HbA1c水平降低了0.70%，FBG降低了1.00 mmol/L，PBG降低了1.61 mmol/L（均p＜0.05）；转换后每日胰岛素总剂量和注射频率显著降低（均p＜0.05）；年龄和病程不影响IDegAsp对降低HbA1c的效果。
在从预混胰岛素转换为IDegAsp的情况下，预混制剂中的基础胰岛素剂量可为调整德谷胰岛素剂量提供有价值的参考。IDegAsp在血糖控制方面优于预混胰岛素，每日总剂量和注射频率降低。IDegAsp可能是老年糖尿病患者管理的最佳选择。
