Taylor R, Foster B, Kyne-Grzebalski D, Vanderpump M
Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Diabet Med. 1994 Jul;11(6):551-7. doi: 10.1111/j.1464-5491.1994.tb02034.x.
A randomized prospective study was conducted to determine whether the insulin regimen for NIDDM subjects poorly controlled on oral therapy should be designed primarily to control basal metabolism or to control mealtime hyperglycaemia. Grossly obese subjects were excluded. After a 2-month run-in phase involving intensive education, subjects were randomized to therapy with twice daily isophane or three times daily soluble insulin. Both Protaphane and Actrapid brought about similar improvement in HbA1 (9.5 +/- 0.5 and 9.7 +/- 0.4%) compared with baseline (11.7 +/- 0.5%; p < 0.001). Diurnal blood glucose profiles showed that despite the good post-prandial control achieved by pre-meal soluble insulin, loss of control occurred overnight, resulting in higher fasting blood glucose levels compared with Protaphane therapy (8.0 +/- 0.8 vs 10.6 +/- 0.8 mmol l-1; p < 0.05). The overall rate of hypoglycaemia was 0.44 patient-1 year-1. Thirty-two mild hypoglycaemic episodes occurred on Protaphane therapy and 79 on Actrapid therapy. Using formal psychometric tests it was shown that insulin therapy was associated with improved treatment satisfaction and that this was greater on Protaphane therapy (p < 0.05). Overall well-being increased similarly in the two groups. All subjects wished to continue with insulin therapy after the conclusion of the study. The insulin regimen for moderately or poorly controlled non-insulin-dependent diabetes should primarily be designed to correct the basal insulin deficiency rather than to mimic normal meal-induced insulin secretion.
进行了一项随机前瞻性研究，以确定对于口服治疗控制不佳的非胰岛素依赖型糖尿病（NIDDM）患者，胰岛素治疗方案应主要设计用于控制基础代谢还是控制进餐时的高血糖。严重肥胖的患者被排除在外。在经过为期2个月的强化教育导入期后，患者被随机分为接受每日两次低精蛋白胰岛素或每日三次可溶性胰岛素治疗。与基线水平（11.7±0.5%）相比，低精蛋白胰岛素和可溶性胰岛素均使糖化血红蛋白（HbA1）有相似程度的改善（分别为9.5±0.5%和9.7±0.4%；p<0.001）。昼夜血糖谱显示，尽管餐前可溶性胰岛素实现了良好的餐后血糖控制，但夜间出现了血糖失控，与低精蛋白胰岛素治疗相比，空腹血糖水平更高（8.0±0.8对10.6±0.8 mmol/L；p<0.05）。低血糖的总体发生率为0.44次/患者·年。低精蛋白胰岛素治疗发生32次轻度低血糖事件，可溶性胰岛素治疗发生79次。通过正式的心理测量测试表明，胰岛素治疗与治疗满意度的提高相关，且低精蛋白胰岛素治疗的满意度更高（p<0.05）。两组患者的总体幸福感均有类似程度的提高。研究结束后，所有患者都希望继续接受胰岛素治疗。对于中度或控制不佳的非胰岛素依赖型糖尿病患者，胰岛素治疗方案应主要设计用于纠正基础胰岛素缺乏，而非模拟正常进餐诱导的胰岛素分泌。
