·糖尿病的胰岛素治疗·

　　 李文华 林梅 刘永健

　　 作者单位：430033武汉，华中科技大学同济医学院附属普爱医院内分泌科

　　【摘要】目的比较口服降糖药(OAD)血糖控制不佳的老年T2DM患者,加用地特胰岛素、甘精胰岛素或中性鱼精蛋白锌胰岛素(NPH)治疗的有效性和安全性。方法114例OAD血糖控制不佳的老年T2DM患者随机分为三组，分别加用地特胰岛素(Det组)、甘精胰岛素(Gla组)或NPH(NPH组)，治疗24周。结果治疗24周后，三组HbA1c、FBG和2hBG均较基线下降，但三组间差异无统计学意义(P>0.05);胰岛素用量在三组间无统计学差异(P>0.05);Det组体重增加较Gla组和NPH组更少(P<0.05或P<0.01); Det组及Gla组低血糖发生率为0.9%，较NPH组的5.3%更低(P<0.01)。结论OAD血糖控制不佳的老年T2DM患者，加用地特胰岛素、甘精胰岛素或NPH均可有效控制血糖，但地特胰岛素在减少体重增加及低血糖发生上更有优势。

　　【关键词】老年;糖尿病，2型;地特胰岛素;甘精胰岛素;中性鱼精蛋白锌胰岛素

　　doi:10.3969/j.issn.1006-6187.2012.01.013

　　A clinical use of insulin detemir in the elderly with type 2 diabetesLI Wen-hua,LIN Mei,LIU Yong-jian. Department of Endocrinology，Puai Hospital，Tongji Medical College，Huazhong University of Science and Technology,Wuhan 430033,China

　　【Abstract】ObjectiveTo compare the efficacy and safety among bedtime-daily detemir， glargine and neutral protamine hagedorn(NPH) in poorly controlled elderly type 2 diabetes(T2DM)with oral antidiabetic drugs(OAD).Methods114 elderly T2DM patients were randomized to three groups receiving insulin detemir or glargine or NPH bedtime-daily for 24 weeks.ResultsFBG，2hBG and HbA1c were significantly decreased after versus before treatment (P<0.05),but there were no statistical differences in changes of FBG, 2hBG and HbA1c among three groups (all P>0.05). Dosage were similar among three groups [Det (18.5±2.3) U,Gla (19.2±2.7) U,NPH (16.5±1.4) U, all P>0.05]. The increased weight was less in detemir than in glargine and NPH groups (P<0.05,P<0.01). Hypoglycemic rate was lower in detemir (0.9%) and glargine (0.9%) groups than in NPH (5.3%) group (P<0.01). ConclusionAdding glargine，detemir and NPH to OAD in poorly controlled T2DM patients could control the glycemia effectively,but detemir can achieve better benefit in reducing weight gain and the incidence of hypoglycemia.

　　【Key words】Elderly; Diabetes mellitus, type 2 ;Insulin detemir;Insulin glargine;Insulin NPH