摘要目的 探讨口服降糖药物治疗不佳的2型糖尿病患者联合基础胰岛素治疗的有效性和安全性。方法 选择2013年1月～2015年6月我院门诊及住院部口服降糖药治疗不佳的2型糖尿病患者100例，在原有口服降糖药物基础上加用基础胰岛素，根据其选择基础胰岛素不同将其分为中性鱼精蛋白锌（NPH）胰岛素组（33例）、甘精胰岛素组（34例）和地特胰岛素组（33例）。比较治疗前后三组血糖（FPG、2 h PG）、糖化血红蛋白（HbA1c）、体重指数（BMI）、低血糖发生率及生活质量等指标。结果 治疗后三组FPG、2 h PG、HbA1c与治疗前比较均有显著降低（P＜0.01），NPH胰岛素组BMI与治疗前比增加（P＜0.05），甘精胰岛素组及地特胰岛素组BMI与治疗前比较，差异无统计学意义（P＞0.05）。与NPH胰岛素组比较，甘精胰岛素组及地特胰岛素组低血糖发生率更低（P＜0.05）。三组治疗后生活质量评分（EQ-5D）与治疗前比均有显著性增加（P＜0.05）。结论对于多种口服降糖药物治疗不佳的2型糖尿病患者及时启用基础胰岛素安全有效，长效胰岛素类似物有效性和安全性更好。
Abstract：Objective To explore the efficacy and safety of basal insulin therapy in combiantion in type 2 diabetes mellitus patients who took hypoglycemic agents orally and didn′t obtain a favorable effect.Methods From January 2013 to June 2015,100 patients with T2DM from outpatient clinics and inpatient departments in unsatisfied effect when oral administration of hypoglycemic agents in our hospital were selected and they were asked to add basal insulin therapy besides oral administration of hypoglycemic agents.According to different types of basal insulin,they were divided into neutral protamine hagedorn(NPH)insulin group(n=33),insulin glargine group(n=34)and insulin detemir group(n=33). The indexes of FPG,2 h PG,HbA1c,BMI,occurrence of hypoglycemia,and quality of life among three groups before and after therapy were compared.Results After treatment,the levels of FPG,2 h PG and HbA1c were significantly decreased than before treatment(P＜0.01).The BMI in the NPH insulin group was increased compared with that before treatment (P＜0.05),while BMI in the insulin glargine group and insulin detemir group were compared before treatment,with no statisticant difference (P＞0.05).Compared with the NPH insulin group,occurrence of hypoglycemia in the insulin glargine group and insulin detemir group was much lower (P＜0.05).The scores of EQ-5D after therapy in the three groups were remarkably increased compared with those before treatment(P＜0.05).Conclusion For T2DM patients who take hypoglycemic agents orally without a great effect,initiation of basal insulin in time is safe and effective,which is better by long-acting insulin analogues in effectiveness and safety.
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