2型糖尿病胰岛素泵强化治疗后胰岛素剂量谱的分析及应用

doi:10.3969/j.issn.1004-583X.2024.07.006

临床荟萃 ›› 2024, Vol. 39 ›› Issue (7): 620-624.doi: 10.3969/j.issn.1004-583X.2024.07.006

2型糖尿病胰岛素泵强化治疗后胰岛素剂量谱的分析及应用

杜斯娜¹^,², 李伟³, 林雅静⁴, 孙建国⁵, 毛毛², 陈坚伟², 孙丹波⁶, 毛玉山⁷()

1.宁波大学医学部,浙江宁波 315211
2.慈溪市人民医院医疗健康集团(慈溪市人民医院)内分泌科, 浙江宁波 315300
3.宁波市医疗中心李惠利医院内分泌科, 浙江宁波 315048
4.宁海县第一医院内分泌科,浙江宁波 315699
5.宁波开发区中心医院内分泌科,浙江宁波 315899
6.慈溪市第三人民医院医疗健康集团长河分院,浙江宁波 315326
7.宁波大学附属第一医院外滩院区内分泌科, 浙江宁波 315020

收稿日期:2024-04-07 出版日期:2024-07-20 发布日期:2024-08-02
通讯作者: 毛玉山 E-mail:zhys007@sina.com
基金资助:
宁波市科技服务业示范项目——基于人工智能的糖尿病移动网络教育示范平台的构建研究(2019F1007);宁波市医学科技计划项目——糖尿病夜间低血糖“心率变化预警阈值”的临床研究(2019Y66);温州医科大学2023年度课程思政教学创新改革项目——“医患共情”的人文思政视域下糖尿病患者性功能疾患的课程教学的实践与研究(KCSZJG202332)

Application of insulin dose spectrum after an intensive insulin pump therapy in type 2 diabetes mellitus

Du Sina¹^,², Li Wei³, Lin Yajing⁴, Sun Jianguo⁵, Mao Mao², Chen Jianwei², Sun Danbo⁶, Mao Yushan⁷()

1. Department of Medicine, Ningbo University, Ningbo 315211, China
2. Department of Endocrinology, Cixi People's Hospital Medical and Healthcare Group (Cixi People's Hospital), Ningbo 315300, China
3. Department of Endocrinology, Li Huili Hospital,Ningbo Medical Center, Ningbo 315048,China
4. Department of Endocrinology,the First Hospital of Ninghai County, Ningbo 315699,China
5. Department of Endocrinology, Ningbo Development Zone Center Hospital, Ningbo 315899, China
6. Changhe Branch, Cixi Third People 's Hospital Medical Health Group, Ningbo 315326, China
7. Department of Endocrinology, Bund Hospital, The First Affiliated Hospital of Ningbo University, Ningbo 315020,China

Received:2024-04-07 Online:2024-07-20 Published:2024-08-02
Contact: Mao Yushan E-mail:zhys007@sina.com

摘要/Abstract

摘要：

目的探讨2型糖尿病(type 2 diabetesmellius,T2DM)患者预混胰岛素类似物的治疗时间、治疗时机和种类。方法收集中国宁波市5家医院应用CSII短期强化治疗的2型糖尿病患者655例,分析确定最佳预混胰岛素类似物治疗方案。结果 CSII滴定后胰岛素用量,餐前胰岛素总量/基础胰岛素总量比值为1.12;胰岛素总量(51.35±29.7) U。晚餐前有58%推荐中预混胰岛素类似物为宜。早餐前74%推荐低预混胰岛素类似物为宜。根据患者个体化巧妙搭配不同剂型预混胰岛素类似物来达到最佳的控制血糖的效果。预混一天两次注射(BID)早晚推断剂量均值比为3∶2。早多晚少的预混胰岛素类似物剂量比值有助于更简易地告知患者胰岛素的剂量,避免早晚剂量的混淆导致低血糖的发生。胰岛素泵强化治疗的结果显示:糖尿病患者的胰岛素剂量谱具有极大的异质性,量化的选择更有意义。结论一天两次注射(BID)预混胰岛素类似物方案: 晚餐前推荐中预混为宜,早餐前推荐低预混为宜。临床上大部分患者选用单种胰岛素治疗,医生可根据患者血糖、个体差异,或联合口服降糖药,在两款剂型中选择最佳方案。

关键词: 糖尿病,2型, 胰岛素泵, 胰岛素剂量谱, 预混胰岛素

Abstract:

Objective To explore the treatment time, timing and type of premixed insulin analogs in patients with type 2 diabetes mellitus (T2DM). Methods A total of 655 T2DM patients treated with continuous subcutaneous insulin infusion(CSII) short-term intensive treatment in 5 hospitals in Ningbo City, China were recruited to determine the optimal treatment plan of premixed insulin analogs. Results After CSII titration, the ratio of insulin dosage before meals to total basal insulin was 1.12, with the total insulin dosage of 51.35±29.7 U. 58% of T2DM patients were recommended to the use of premixed insulin analogs before dinner. 74% of them were recommended to the use of low premixed insulin analogs before breakfast. An individualized preparation of premixed insulin analogs with varied dosage formulations was expected to yield the optimal goal to control blood sugar. An inferred ratio of premixed insulin analogs twice a day (b.i.d.) in the morning and evening was 3∶2. A higher dosage in the morning than evening favored a simple informed consent of insulin dosage, thus preventing the misuse of premixed insulin analog dosages in the morning and evening and the incidence of hypoglycemia. An intensive insulin pump therapy showed that the insulin dose spectrum of T2DM was extremely heterogeneous, and a quantitative selection was of more significance. Conclusion A premixed insulin analog regimen b.i.d. is recommended, with a medium premixing before dinner, and low premixing before breakfast. A single type of insulin is dominant in clinical treatment of T2DM. An optimal regimen of the two types of premixed insulin analogs, either combined with oral hypoglycemic drugs or not, can be selected based on the individualized conditions of blood sugar.

Key words: diabetes mellitus, type 2, insulin pump, insulin dose profile, premixed insulin

中图分类号:

R587.1

杜斯娜, 李伟, 林雅静, 孙建国, 毛毛, 陈坚伟, 孙丹波, 毛玉山. 2型糖尿病胰岛素泵强化治疗后胰岛素剂量谱的分析及应用[J]. 临床荟萃, 2024, 39(7): 620-624.

Du Sina, Li Wei, Lin Yajing, Sun Jianguo, Mao Mao, Chen Jianwei, Sun Danbo, Mao Yushan. Application of insulin dose spectrum after an intensive insulin pump therapy in type 2 diabetes mellitus[J]. Clinical Focus, 2024, 39(7): 620-624.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.07.006

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I7/620

图/表 7

图1 CSII滴定结束后血糖控制情况

Fig.1 Blood glucose control after CSII titration

图2 CSII滴定后胰岛素用量及模拟BID剂量

Fig. 2 Insulin dosage after CSII titration and simulated dosage for BID

表1 CSII滴定后模拟预混胰岛素类似物转换比例

Tab.1 Simulated conversion ratio of premixed insulin analogues after CSII titration

模拟晚餐前品种	例数	模拟早餐前品种与晚餐前品种匹配
模拟晚餐前品种	例数	中预混	低预混
中预混	379	121	258
低预混	276	227	49

图3 晚餐前预混胰岛素剂型预测分布

Fig.3 Prediction distribution of premixed insulin dosage forms before dinner

图4 晚餐预测中预混组早餐预测剂型分布

Fig.4 Distribution of the dosage form of middle premixed insulin analogs for breakfast predicted in dinner

图5 晚餐前预测低预混组早餐预测剂型分布

Fig.5 Distribution of the dosage form of low premixed insulin analogs for breakfast predicted before dinner

图6 早餐前选择预混胰岛素类似物剂型的分布

Fig.6 Distribution of dosage forms of premixed insulin analog selected before breakfast

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2型糖尿病胰岛素泵强化治疗后胰岛素剂量谱的分析及应用

Application of insulin dose spectrum after an intensive insulin pump therapy in type 2 diabetes mellitus

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