Langdon D R, James F D, Sperling M A
J Pediatr. 1981 Dec;99(6):854-61. doi: 10.1016/s0022-3476(81)80006-6.
It has been asserted that twice daily injections of mixed insulin provide better blood glucose control than one. To compare the two regimens we conducted a random-order, double-crossover trial in ten diabetic children. Each regimen lasted for six weeks, concluding with a hospital evaluation. Control at home was assessed by a urine log and determination of glycosylated hemoglobin. Control in the hospital was assessed with measurements of quantitative urinary glucose, serum lipids, and by 24-hour blood sampling for glucose, C-peptide, and counterregulatory hormones. For the group as a whole, none of the indices of control demonstrated a significant advantage for either regimen. Individually, several children did appear to achieve better control on one regimen than the other. Indices of control at home did not consistently predict control in the hospital. In the hospital, the largest increases in glucose concentration followed breakfast (mean rise 148 mg/dl), and standardized exercise invariably reduced plasma glucose values (mean decrement 60 mg/dl). C-Peptide concentrations were low, but higher values were associated with better control. Although a split insulin regimen may improve metabolic control in some patients, this study did not demonstrate a substantial advantage for the majority of subjects over the short period of the trials.
有人断言，每日两次注射混合胰岛素比每日一次能更好地控制血糖。为比较这两种治疗方案，我们对10名糖尿病儿童进行了随机顺序、双交叉试验。每种方案持续6周，最后进行一次医院评估。通过尿糖记录和糖化血红蛋白测定来评估在家中的血糖控制情况。通过定量尿糖测量、血脂检测以及24小时血糖、C肽和反调节激素血样采集来评估在医院的血糖控制情况。对于整个研究组而言，两种治疗方案在任何一项控制指标上均未显示出显著优势。个别来看，有几个儿童采用一种方案时的控制效果似乎比另一种更好。在家中的控制指标并不能始终如一地预测在医院的控制情况。在医院里，早餐后血糖浓度升高幅度最大（平均升高148毫克/分升），而标准化运动总能降低血糖值（平均降低60毫克/分升）。C肽浓度较低，但较高的值与更好的血糖控制相关。虽然胰岛素分剂治疗方案可能会改善部分患者的代谢控制，但本研究并未表明在试验的短时间内，大多数受试者采用该方案有实质性优势。
