Tsui E Y, Chiasson J L, Tildesley H, Barnie A, Simkins S, Strack T, Zinman B
Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
Diabetes Care. 1998 Jan;21(1):93-6. doi: 10.2337/diacare.21.1.93.
To determine whether the long-term use of insulin lispro (LP) affects the counterregulatory hormone response to hypoglycemia.
Ten patients (age range 26-51 years; ratio of men to women 9:1; BMI 24.9 +/- 0.48; mean HbA1c 7.84 +/- 0.25%) with IDDM, treated with continuous subcutaneous insulin infusion (CSII; Disetronic H-TRON V100) were studied using a double-blind, crossover design. Patients were randomized to LP or human regular insulin (HR) for 3 months and then crossed over to the other insulin for an additional 3 months. All meal boluses were given 0-5 min before breakfast, lunch, and dinner. Counterregulatory hormone responses to a stepped hypoglycemic clamp (consecutive glucose levels in mmol/l: 4.2; 3.5; 2.8, each for 1 h) were evaluated at the end of each treatment period.
HbA1c was significantly lower with LP versus HR (7.47 +/- 0.28% vs. 7.9 +/- 0.26%, P = 0.04). The incidence of hypoglycemia per 30 days (capillary blood glucose < 3.0 mmol/l and/or symptoms) during the last month of the study was significantly lower with LP versus HR (8.7 +/- 2.9 vs. 11.8 +/- 2.9, P = 0.03). The total daily insulin dosage was not different in the two treatment periods. There was no episode of severe hypoglycemia or diabetic ketoacidosis. The peak growth hormone, cortisol, glucagon, and epinephrine responses during the same period of hypoglycemia were not different for each treatment period.
The use of LP in CSII results in improved glycemic control and a decrease in the frequency of hypoglycemia without adversely affecting counterregulatory hormone response to hypoglycemia.
确定长期使用赖脯胰岛素（LP）是否会影响对低血糖的反调节激素反应。
采用双盲交叉设计，对10例患有胰岛素依赖型糖尿病（IDDM）且接受持续皮下胰岛素输注（CSII；Disetronic H-TRON V100）治疗的患者（年龄范围26 - 51岁；男女比例9:1；BMI 24.9±0.48；平均糖化血红蛋白[HbA1c] 7.84±0.25%）进行研究。患者被随机分为接受LP或人常规胰岛素（HR）治疗3个月，然后交叉接受另一种胰岛素治疗3个月。所有餐时大剂量胰岛素均在早餐、午餐和晚餐前0 - 5分钟给予。在每个治疗期结束时，评估对逐步低血糖钳夹（血糖水平以mmol/l计依次为：4.2；3.5；2.8，各持续1小时）的反调节激素反应。
与HR相比，LP治疗组的HbA1c显著更低（7.47±0.28%对7.9±0.26%，P = 0.04）。在研究的最后一个月，LP治疗组每30天的低血糖发生率（毛细血管血糖<3.0 mmol/l和/或出现症状）显著低于HR治疗组（8.7±2.9对11.8±2.9，P = 0.03）。两个治疗期的每日胰岛素总剂量无差异。未发生严重低血糖或糖尿病酮症酸中毒事件。每个治疗期在低血糖同一时期的生长激素、皮质醇、胰高血糖素和肾上腺素的峰值反应无差异。
在CSII中使用LP可改善血糖控制并降低低血糖发生频率，且不会对低血糖的反调节激素反应产生不利影响。
