【摘要】目的 研究口服降糖药控制不佳的老年肥胖2型糖尿病患者加用甘精胰岛素或中效胰岛素联合应用治疗的有效性和安全性。方法 口服降糖药控制不佳的老年肥胖2型糖尿病患者61例随机分为成甘精胰岛素组和中效胰岛素组两组，治疗期内阿卡波糖和(或)二甲双胍剂量不变，分别加用甘精胰岛素或中效胰岛素睡前注射一次联合治疗，进行12周的观察。结果 (1)两组HbA1c、FBG、2hPG与治疗前比较以及两组间HbA1c、2hPG比较，差异有统计学意义(P<0.05)，两组间FBG比较则差异无统计学意义(P>0.05);(2)甘精胰岛素组BMI与治疗前比较降低2.7kg/m2，而中效胰岛素组BMI与治疗前比较基本没有改变;(3)甘精胰岛素组和中效胰岛素组分别有45.2%和73.3%的患者发生症状性低血糖，差异有统计学意义(P<0.05);(4) 治疗结束时甘精胰岛素组与中效胰岛素组胰岛素用量分别为(18.7±3.5)U/d和(26.0±3.7)U/d，差异有统计学意义(P<0.05)。结论 口服降糖药血糖控制不佳的老年肥胖2型糖尿病患者，在阿卡波糖和(或)二甲双胍基础上加用甘精胰岛素能有效控制血糖，降低低血糖的发生率并能有效控制体重。

　　【关键词】糖尿病;2型;甘精胰岛素;老年肥胖。

　　Clinical study on the effect of addition of insulin glargine to acarbose or metformin on the type 2 senile obese diabetics WANG Bin1, HU Gui-rong2, HE Li1, et al. 1. Department of Internal Medicine, Foshan Chancheng Zhangcha Hospital, Foshan 528000, China; 2. Department of Internal Medicine, Foshan Chancheng Yong’an Hospital, Foshan 528000, China; 3. Department of Endocrinology, Attached Hospital of Medical College, Foshan University of Science and Technology, Foshan 528000, China

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　　【Abstract】Objective To study the effect and safety of insulin glargine or isophane insulin on the type 2 senile obese diabetic patients who failed to control their blood glucose with oral hypoglycemics. Methods Sixty-one patients who failed to control their blood glucose with oral hypoglycemics was randomized into insulin glargine group and isophane insulin group. They were administered acarbose and/or metformin tablet as usual, but before sleep additionally treated with insulin glargine or isophand insulin respectively for injection. The observation lasted for 12 weeks. Result (1). In both groups the HbA1c, FBG, and 2hPG compared with before treatment, and in the comparison of HbA1c and 2hPG between the two groups, the differences were significant (P<0.05); while there was no significant difference in the comparison of FBG between the two groups (P>0.05). (2). The BMI of the insulin glargine group was reduced 2.7kg/m2 compared with before treatment, while that of the isophand insulin group was basically unchanged compared with before treatment. (3) The 45.2% of patients with insulin glargine treatment and the 73.3% of patients with isophand insulin treatment had symptomatic hypoglycemia, and the difference was statistically significant (P<0.05). (4). At the end of treatment, the dose of insulin glargine group and isophand insulin group was (18.7±3.5)U/d and (18.7±3.5)U/d respectively, and the difference was statistically significant (P<0.05). Conclusion The combination of insulin glargine with acarbose and/or metformin is effective in controlling the blood glucose, decreasing the incidence of hypoglycemia, and controlling the body weight of type 2 senile obese diabetic patients.

　　【Keywords】Diabetic mellitus, type 2; Insulin glargine; Senile obesity