【摘要】 目的 使用动态血糖监测系统(CGMS)比较地特胰岛素与甘精胰岛素联合门冬胰岛素强化控糖后T2DM患者全天血糖波动情况。 方法 60例使用口服降糖药物治疗的血糖控制不佳的T2DM患者，入院后先进行胰岛素泵强化控糖治疗，患者血糖达到目标值后(FPG<7.0mmol/L,2hPG<10.0mmol/L)按1：1的比例随机分为两组，一组用三餐前门冬胰岛素联合睡前甘精胰岛素(Asp+Gla组)，另一组用三餐前门冬胰岛素联合睡前地特胰岛素(Asp+Det组)继续强化控制血糖，在患者FPG达标后(5.6mmol/L)为患者佩戴CGMS，获取患者第三个24h内平均血糖(MBG)、最大血糖波动幅度(LAGE)、日内平均血糖波动幅度(MAGE)、以及患者达标时的治疗天数，比较达标时甘精胰岛素及地特胰岛素使用剂量以及低血糖等不良事件的发生率。结果 FPG达标后，两组患者在血糖达标的时间、达标时基础胰岛素用量、总胰岛素用量方面，无明显差异(P>0.05)。CGMS记录的第3个24h内MBG、LAGE，MAGE：两组患者血糖波动情况相似(P>0.05)。在低血糖发生率的比较中，Gla+Asp组低血糖发生率为3.0%，Det +Asp组低血糖发生率为2.0%，两组低血糖发生率比较无显著差异(P>0.05)。结论 两组治疗方案均可较好的控制血糖，在两者FPG达标后，甘精胰岛素和地特胰岛素在控制患者全天血糖波动情况上效果相似，差异无统计学意义(P>0.05)，在低血糖事件的发生率上，也无明显差异(P>0.05)。

　　【关键词】 动态血糖监测系统;糖尿病，2型;甘精胰岛素;地特胰岛素

　　Using the continuous glucose monitoring system (CGMS) to compare the blood glucose fluctuations in patients with type 2 diabetes after intensive blood glucose control of insulin detemir and insulin glargine combined with insulin aspart GUO Wen, XU Xiang-jin, LIN Yi-yang, et al. Department of Endocrinology, Fuzhou General Hospital, Nanjing Military Area Command, Fuzhou 350025, China

　　【Abstract】Objective To compare blood glucose fluctuation in patients with type 2 diabetes after intensive blood glucose control of insulin detemir and insulin glargine combined with insulin aspart throughout the day by using continuous glucose monitoring system (CGMS). Methods The 60 ​​T2DM patients previously treated with oral antihyperglycemic drugs with poor glycemic control first received continuous subcutaneous insulin infusion (CSII) therapy. After their blood glucose had reached the goal (FPG<7.0mmol/L, 2hPG<10.0mmol/L), they were randomized in a 1:1 ratio into two groups. One group was treated with insulin aspart before meals combined with bedtime insulin glargine (Asp + Gla group), and the other group with mealtime insulin aspart jointed with bedtime basal insulin detemir (Asp+Det group). The glucose levels were monitored with CGMS once fasting plasma glucose achieved the target (5.6mmol/L) to obtain the third 24h mean blood glucose (MBG), the largest amplitude of glycemic excursions (LAGE), the mean amplitude of glycemic excursions (MAGE) within one day, and the number of days when up to the standard to compare the insulin doses that needed to reach the goal, as well as the incidence of hypoglycemia events. Results After the FPG reached the goal, there was no significant differences observed in the time, basal and total insulin dosage used in the two groups (P>0.05). Measured by the third 24h MBG, LAGE and MAGE recorded by CGMS, the blood glucose fluctuation in the two groups was similar (P>0.05). In the comparison of incidence of hypoglycemia, the result was that it was 3% in the Gla+Asp group and 2.0% in the Det+Asp group, without significant difference between them (P>0.05). Conclusions Both groups have a good control of blood glucose. After the FPG reaches the goal, a similar effect on the control of blood glucose fluctuation of the two groups is achieved (P>0.05), and there isn’t significant difference between them in the incidence of hypoglycemia either (P>0.05).

　　【Key words】Continuous glucose monitoring system (CGMS); Diabetes mellitus, type 2; Insulin detemir; Insulin glargine