糖尿病胰岛素治疗

　　【摘要】目的 探讨T2DM患者胰岛素治疗的优化方案及其相关因素分析。方法 回顾分析606例胰岛素治疗的T2DM患者资料，观察达标血糖所用的天数、达标血糖时胰岛素剂量及出院时的胰岛素剂量，并记录低血糖发生的情况。主要终点目标统计方法，比较出院时FBG与血糖基线值差值。用fisher精确概率法检验分析低血糖。结果 受试者用胰岛素治疗后达到目标血糖所需的时间为(6.6±1.4)d，平均胰岛素使用总量(38.99±7.87)U/d，单位体重的胰岛素量(0.59±0.07)U/kg。治疗中发生低血糖症(1.2±0.38)次/人、无症状低血糖(0.8 ±0.32次/人)、低血糖反应(1.98±0.46)次/人。主要终点目标分析，各组出院时血糖值与基线比较均明显降低，但两两比较差异无统计学意义。结论 单位体重胰岛素剂量与病程、HbA1c呈正相关，与年龄呈负相关。依据个体化原则，依据部分患者胰岛素注射剂量、依从性和低血糖发生率，可能适合每天一次注射胰岛素。

　　[关键词] 糖尿病,2型; 胰岛素; 胰岛素治疗; 达标剂量; 优化方案

　　【Abstract】 Objective To investigate the optimization program of insulin therapy in type 2 diabetic patients and its related factors analysis. Methods The data of 606 cases of type 2 diabetic patients who received insulin therapy were analyzed retrospectively. The days spent and insulin doses at targeted blood glucose and insulin doses at discharge were observed. The circumstances of hypoglycemia occurred were recorded. With the primary endpoint objective statistical methods, the difference between FBG and the baseline blood glucose at discharge was compared. Fisher exact probabilistic method test was used to analyze the hypoglycemia cases. Results The time needed to reach the targeted blood glucose of subjects treated with insulin was (6.6±1.4) d, the average total amount of insulin used was (38.99±7.87) U/d, and the amount of insulin per body weight was (0.59±0.07) U/kg. Hypoglycemia occurred in treatment was (1.2±0.38) times/person, asymptomatic hypoglycemia was (0.8±0.32) times/person, and hypoglycemic reaction was (1.98±0.46) times/person. The blood glucose values at discharge in each group compared with the baseline were decreased significantly by the primary end-point target analysis, but the difference of comparison between two groups was not statistically significant. Conclusions: The insulin dosage per body weight is positively correlated with duration of diabetes and HbA1c, but is negatively correlated with the age. Based on the principle of individualization, depending on the insulin dosage, compliance, and the incidence of hypoglycemia in some patients, it may be suitable to inject insulin once daily.

　　[Key words] Diabetes mellitus, type 2; Insulin; Insulin treatment; Targeted insulin dosage; The optimization program