Wolffenbuttel B H, Sels J P, Rondas-Colbers G J, Menheere P P, Nieuwenhuijzen Kruseman A C
Department of Internal Medicine, University Hospital Maastricht, The Netherlands.
Diabetes Care. 1996 Dec;19(12):1326-32. doi: 10.2337/diacare.19.12.1326.
To compare the metabolic effects of three different frequently used regimens of insulin administration on blood glucose control and serum lipids, and the costs associated with this treatment, in subjects with NIDDM, who were poorly controlled with oral antihyperglycemic agents.
We studied 95 elderly patients with NIDDM (age 68 +/- 9 years, BMI 26.0 +/- 4.6 kg/m2, and median time since diagnosis of diabetes 9 years [range 1-37]; 37 men, 58 women), who were poorly controlled, despite diet and maximal doses of oral antihyperglycemic agents. Three insulin administration regimens were compared during a 6-month period: patients were randomized for treatment with a two-injection scheme (regimen A) or a combination of glibenclamide with one injection of NPH insulin, administered either at bedtime (regimen B) or before breakfast (regimen C), and insulin treatment was mainly instituted in an outpatient setting.
After 6 months of insulin treatment, fasting blood glucose of the total patient population had decreased from an average of 14.1 +/- 2.2 to 8.3 +/- 2.0 mmol/L (P < 0.001), and HbA1c fell from 11.0 +/- 1.3 to 8.3 +/- 1.2% (P < 0.001); 34 patients reached HbA1c levels below 8.0%, 25 of them even below 7.5%. With two insulin injections daily, HbA1c decreased from 11.2 +/- 1.3 to 8.2 +/- 1.2%, while during combined treatment, HbA1c fell from 10.5 +/- 1.2 to 8.1 +/- 1.1% (regimen B) and from 11.1 +/- 1.3 to 8.5 +/- 1.1% (regimen C). Comparable improvement of the other measures of glycemic control, lipids and lipoproteins, was observed in the different treatment regimens. Body weight increase was moderate (mean +/- 4.0 kg) and similar in all patient groups. One-third of patients starting with one insulin injection daily needed a second injection to control glycemia. One episode of severe hypoglycemia was observed. Combined insulin-sulfonylurea treatment was almost 20% more expensive than twice-daily administration of insulin alone.
Insulin treatment can safely be instituted in elderly patients with NIDDM. However, it is difficult to obtain optimal glycemic control. Insulin has moderate beneficial effects on serum lipoproteins. Although on the basis of glycemic control and weight gain, no preference for any treatment regimen can be discerned, twice-daily insulin administration is the most simple and cost-effective regimen.
比较三种不同常用胰岛素给药方案对非胰岛素依赖型糖尿病（NIDDM）患者血糖控制、血脂的代谢影响以及该治疗相关的费用，这些患者口服降糖药控制不佳。
我们研究了95例老年NIDDM患者（年龄68±9岁，体重指数26.0±4.6kg/m²，糖尿病诊断后中位时间9年[范围1 - 37年]；37例男性，58例女性），尽管采用了饮食控制和最大剂量的口服降糖药，但其病情仍控制不佳。在6个月期间比较了三种胰岛素给药方案：患者被随机分为两组，一组接受两次注射方案（方案A），另一组接受格列本脲与一次中性鱼精蛋白锌胰岛素（NPH）联合注射，分别在睡前（方案B）或早餐前（方案C）给药，胰岛素治疗主要在门诊进行。
胰岛素治疗6个月后，全部患者的空腹血糖从平均14.1±2.2mmol/L降至8.3±2.0mmol/L（P<0.001），糖化血红蛋白（HbA1c）从11.0±1.3%降至8.3±1.2%（P<0.001）；34例患者的HbA1c水平降至8.0%以下，其中25例甚至低于7.5%。每日两次注射胰岛素时，HbA1c从11.2±1.3%降至8.2±1.2%，而联合治疗时，HbA1c从10.5±1.2%降至8.1±1.1%（方案B），从11.1±1.3%降至8.5±1.1%（方案C）。在不同治疗方案中观察到血糖控制、血脂和脂蛋白的其他指标有类似改善。体重增加适中（平均±4.0kg），在所有患者组中相似。开始每日一次注射胰岛素的患者中有三分之一需要第二次注射以控制血糖。观察到1次严重低血糖事件。胰岛素 - 磺脲类联合治疗比每日两次单独注射胰岛素贵近20%。
胰岛素治疗可安全用于老年NIDDM患者。然而，很难实现最佳血糖控制。胰岛素对血清脂蛋白有中等程度的有益作用。尽管基于血糖控制和体重增加，无法看出对任何治疗方案有偏好，但每日两次注射胰岛素是最简单且最具成本效益的方案。
