德谷门冬双胰岛素与门冬胰岛素持续皮下输注治疗非内分泌科糖尿病患者的短期疗效比较

doi:10.3969/j.issn.1004-583X.2023.02.006

摘要/Abstract

摘要：

目的探讨德谷门冬双胰岛素与门冬胰岛素持续皮下输注在院内非内分泌科住院的糖尿病患者中治疗的有效性及安全性。方法回顾性分析2021年12月至2022年6月于郑州大学第五附属医院非内分泌科住院应用门冬胰岛素30注射液但血糖不达标的糖尿病患者82例,其中调整为德谷门冬双胰岛素治疗50例(德谷门冬组),调整为胰岛素泵持续皮下输注门冬胰岛素治疗组32例(胰岛素泵组)。分析两组一般特征,治疗前后血糖、胰岛素用量变化,血糖达标时间,血糖在目标范围内的时间,血糖波动指标[平均血糖波动幅度(mean amplitude of glycemic excursion,MAGE)、血糖标准差(standard deviation of blood glucose, SDBG)、最大血糖波动幅度、日间血糖平均绝对差(absolute means of daily difference, MODD)],血糖达标时胰岛素用量,低血糖发生情况,患者及相关科室医生满意度等。结果治疗10天后两组血糖均明显下降,胰岛素用量均较治疗前明显减少(P<0.05);空腹血糖、治疗前后血糖变化、胰岛素用量变化、医生满意度两组差异无统计学意义(P>0.05);德谷门冬组低血糖发生率较低、患者满意度较高,两组差异有统计学意义(P<0.01);德谷门冬组SDBG、MAGE、MODD、血糖达标时间劣于胰岛素泵组,差异有统计学意义(P<0.05)。结论在非内分泌科住院的糖尿病患者中,德谷门冬双胰岛素与门冬胰岛素持续皮下输注均能有效控制血糖达标,节约胰岛素用量;德谷门冬胰岛素低血糖风险更低,患者满意度更高,但血糖达标时间较长、血糖波动较大。

关键词: 糖尿病, 双相胰岛素, 血糖控制, 血糖在目标范围内时间

Abstract:

Objective To observe the efficacy and safety of insulin degludec/insulin aspart (IDegAsp) and continuous subcutaneous infusion (CSI) of insulin aspartate for diabetic inpatients in non-endocrinology departments. Methods From December 2021 to June 2022, 82 diabetic inpatients admitted to the in non-endocrinology departments, the Fifth Affiliated Hospital of Zhengzhou University, who had uncontrolled blood glucose after injections of insulin aspart-30 were retrospectively analyzed. They were randomly allocated into IDegAsp group (n=50) and CSI group(n=32), and patients in the two groups were intervened by IDegAsp infusion and CSI of insulin aspartate, respectively. Clinical data were compared between groups, including fasting blood glucose (FBG) and insulin dosage before and after treatment, time to achieve a standard FBG, time to achieve targeted FBG, FBG fluctuation indexes like mean amplitude of glycemic excursion (MAGE), standard deviation of blood glucose (SDBG), maximum blood glucose fluctuation and absolute means of daily difference (MODD), and insulin dosage at the standard FBG, incidence of hypoglycemia, and patient’s and doctor’s satisfaction. Results On day 10, FBG and insulin dosage in both groups were significantly reduced (P<0.05). There were no significant differences in FBG and blood glucose changes before and after treatment, insulin dosage changes and doctor’s satisfaction, changes in blood glucose and insulin dosage and satisfaction of doctors between the two groups (P>0.05). The incidence of hypoglycemia was significantly lower in the IDegAsp group than that in CSI group, while the patient’s satisfaction was significantly higher (P<0.01). SDBG, MAGE, MODD and time to achieve standard FBG in Deguaspart group were obviously inferior to those in CSI group (P<0.05). Conclusion For diabetic patients in non-endocrinology departments, both IDegAsp and CSI of insulin aspartate can effectively control blood glucose and lowerinsulin dosage, and the former is featured by a low risk of hypoglycemia, high patient’s satisfaction, long time to achieve target FBG and large blood glucose fluctuations.

Key words: diabetes mellitus, biphasic insulin, blood glucose control, time to achieve target blood glucose

中图分类号:

R587.1

饶小娟, 史双伟, 桑艳红. 德谷门冬双胰岛素与门冬胰岛素持续皮下输注治疗非内分泌科糖尿病患者的短期疗效比较[J]. 临床荟萃, 2023, 38(2): 132-136.

Rao Xiaojuan, Shi Shuangwei, Sang Yanhong. Comparison of short-term efficacy of insulin degludec/insulin versus continuous subcutaneous infusion of insulin asparton diabetic patients admitted in non-endocrinology departments[J]. Clinical Focus, 2023, 38(2): 132-136.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.02.006

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I2/132

图/表 4

表1 两组基线特征比较

Tab.1 Comparison of baseline features between groups

组别	例数	性别 (男/女)	年龄 (岁)	BMI (kg/m²)	糖尿病病程 (年)	HbA₁c (%)	FPG (mmol/L)	空腹C肽 (ng/ml)
德谷门冬组	50	26/24	57.60±6.31	25.29±1.95	8.40±2.32	10.51±1.26	11.18±1.53	1.19±0.34
胰岛素泵组	32	14/18	57.06±5.85	25.27±1.97	8.63±1.74	10.84±1.34	10.98±1.56	1.15±0.27
$t$ /χ²值		0.581	0.202	0.248	1.243	0.602	0.471	1.237
$P$ 值		0.143	0.818	0.781	0.296	0.551	0.627	0.298

表1 两组基线特征比较

Tab.1 Comparison of baseline features between groups

组别	例数	性别 (男/女)	年龄 (岁)	BMI (kg/m²)	糖尿病病程 (年)	HbA₁c (%)	FPG (mmol/L)	空腹C肽 (ng/ml)
德谷门冬组	50	26/24	57.60±6.31	25.29±1.95	8.40±2.32	10.51±1.26	11.18±1.53	1.19±0.34
胰岛素泵组	32	14/18	57.06±5.85	25.27±1.97	8.63±1.74	10.84±1.34	10.98±1.56	1.15±0.27
$t$ /χ²值		0.581	0.202	0.248	1.243	0.602	0.471	1.237
$P$ 值		0.143	0.818	0.781	0.296	0.551	0.627	0.298

表2 两组治疗前后血糖及胰岛素用量比较($\bar{x}±s$)

Tab.2 Comparison of blood glucose and insulin dosage between groups before and after treatment($\bar{x}±s$)

组别	例数	FPG(mmol/L)			胰岛素用量(U/d)
组别	例数	治疗前	治疗后	变化值	治疗前	治疗后	变化值
德谷门冬组	50	11.18±1.53	6.32±0.51	5.92±2.32^*	39.28±5.64	31.48±5.20	7.28±3.82^*
胰岛素泵组	32	10.98±1.56	6.32±0.47	5.67±2.19^*	36.94±4.44	30.19±4.32	6.98±4.17^*
$t$ 值		1.237	0.187	0.347	0.862	0.984	0.256
$P$ 值		0.298	0.830	0.732	0.428	0.404	0.803

表2 两组治疗前后血糖及胰岛素用量比较($\bar{x}±s$)

Tab.2 Comparison of blood glucose and insulin dosage between groups before and after treatment($\bar{x}±s$)

组别	例数	FPG(mmol/L)			胰岛素用量(U/d)
组别	例数	治疗前	治疗后	变化值	治疗前	治疗后	变化值
德谷门冬组	50	11.18±1.53	6.32±0.51	5.92±2.32^*	39.28±5.64	31.48±5.20	7.28±3.82^*
胰岛素泵组	32	10.98±1.56	6.32±0.47	5.67±2.19^*	36.94±4.44	30.19±4.32	6.98±4.17^*
$t$ 值		1.237	0.187	0.347	0.862	0.984	0.256
$P$ 值		0.298	0.830	0.732	0.428	0.404	0.803

表3 两组治疗10天后血糖波动指标比较($\bar{x}±s$)

Tab.3 Comparison of blood glucose fluctuation indexes between groups after 10 days of treatment($\bar{x}±s$)

组别	例数	TIR(%)	SDBG(mmol/L)	MAGE(mmol/L)	LAGE(mmol/L)	MODD(mmol/L)
德谷门冬组	50	85.58±3.80	2.43±0.39	5.13±0.27	11.97±1.48	0.67±0.19
胰岛素泵组	32	86.29±4.50	1.91±0.34	4.89±0.47	12.58±1.02	0.54±0.20
$t$ 值		0.027	50.103	140.651	1.835	7.603
$P$ 值		0.937	0.000	0.000	0.629	0.039

表3 两组治疗10天后血糖波动指标比较($\bar{x}±s$)

Tab.3 Comparison of blood glucose fluctuation indexes between groups after 10 days of treatment($\bar{x}±s$)

组别	例数	TIR(%)	SDBG(mmol/L)	MAGE(mmol/L)	LAGE(mmol/L)	MODD(mmol/L)
德谷门冬组	50	85.58±3.80	2.43±0.39	5.13±0.27	11.97±1.48	0.67±0.19
胰岛素泵组	32	86.29±4.50	1.91±0.34	4.89±0.47	12.58±1.02	0.54±0.20
$t$ 值		0.027	50.103	140.651	1.835	7.603
$P$ 值		0.937	0.000	0.000	0.629	0.039

表4 两组血糖达标时间、胰岛素用量、低血糖发生率、治疗满意度比较

Tab.4 Comparison of blood glucose standard time, insulin dosage, hypoglycemia rates and treatment satisfaction between groups

组别	例数	血糖达标时间 (d)	血糖达标时胰岛素用量 (U/d)	低血糖 [例(%)]	医生满意度 [例(%)]	患者满意度 [例(%)]
德谷门冬组	50	4.14±0.83	31.48±5.20	1(4.0)	23(92.0)	23(92.0)
胰岛素泵组	32	3.72±0.87	30.19±4.32	3(18.7)	1(93.7)	13(81.3)
$t$ /χ²值		41.423	0.984	34.452	1.048	4.782
$P$ 值		0.000	0.404	0.000	0.306	0.000

表4 两组血糖达标时间、胰岛素用量、低血糖发生率、治疗满意度比较

Tab.4 Comparison of blood glucose standard time, insulin dosage, hypoglycemia rates and treatment satisfaction between groups

组别	例数	血糖达标时间 (d)	血糖达标时胰岛素用量 (U/d)	低血糖 [例(%)]	医生满意度 [例(%)]	患者满意度 [例(%)]
德谷门冬组	50	4.14±0.83	31.48±5.20	1(4.0)	23(92.0)	23(92.0)
胰岛素泵组	32	3.72±0.87	30.19±4.32	3(18.7)	1(93.7)	13(81.3)
$t$ /χ²值		41.423	0.984	34.452	1.048	4.782
$P$ 值		0.000	0.404	0.000	0.306	0.000

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