持续皮下输注赖脯胰岛素治疗老年非初诊2型糖尿病患者临床观察

目的：观察比较持续皮下输注赖脯胰岛素与常规注射预混赖脯胰岛素对老年非初诊2型糖尿病患者的疗效与安全性。方法：将58例老年2型糖尿病患者随机分为观察组（29例）与对照组（29例）,观察组用赖脯胰岛素经胰岛素泵持续皮下输注（CSI-I）,对照组用精蛋白锌重组赖脯胰岛素25注射液,2次／d,常规皮下注射。两组患者均给予糖尿病教育、饮食控制及适量运动,共治疗2周。比较治疗前后两组患者的血糖、胰岛素用量、血糖达标时间以及低血糖发生率。结果：治疗后两组患者空腹血糖、餐后血糖均较治疗前下降（P〈0．05）,观察组血糖达标时间、胰岛素用量均明显低于对照组（P〈0．05）。两组低血糖发生率无明显差异。结论：持续皮下输注赖脯胰岛素具有较好的疗效与安全性,是控制老年非初诊2型糖尿病患者较佳的方法。     

持续皮下胰岛素注射对2型糖尿病合并肺部感染患者的疗效分析

目的:分析持续皮下注射胰岛素对2型糖尿病(T2DM)合并肺部感染患者的临床疗效。方法:将我院2010年6月至2013年6月收治的86例2型糖尿病合并肺部感染患者随机分为2组,分别采用胰岛素泵持续皮下注射(治疗组)和多次皮下注射胰岛素(对照组),观察患者血糖指标、血糖达标时间、低血糖发生率及肺部感染治愈率情况。结果:治疗后,两组患者的血糖均得到控制,治疗组的血糖指标变化、血糖达标时间及住院时间均优于对照组,差异均有统计学意义(均P0.05)。治疗组的低血糖发生率明显低于对照组,而肺部感染治愈率显著高于对照组,差异均有统计学意义(均P0.05)。结论:胰岛素泵持续皮下胰岛素注射在治疗2型糖尿病合并肺部感染患者中使用,血糖达标迅速,降低低血糖发生率,缩短住院时间,提高感染治愈率,临床效果好。     

门冬胰岛素联合地特胰岛素对2型糖尿病强化治疗的疗效评价

目的:探讨地特胰岛素联合门冬胰岛素与生物合成人胰岛素注射液R对2型糖尿病强化治疗的疗效.方法:回顾性分析近年来我院住院治疗的180例2型糖尿病患者的临床资料,随机分为两组,每组90例,观察组予门冬胰岛素联合地特胰岛素治疗,对照组予生物合成人胰岛素注射液R治疗,记录并分析两组治疗前后空腹血糖(FPG)、餐后2小时血糖(2h-PPG)、血糖达标时间、达标时胰岛素用量及低血糖发生情况.结果:观察组较对照组患者在治疗前后糖化血红蛋白值、空腹血糖值都有所降低,血糖达标时间(d),胰岛素日用量(U/kg*d)及低血糖发生率(次/人)都有所减少,疗前后Homa-IR有所降低,Homa-β及体重有所增加,两组患者在治疗后糖尿病并发症都有所好转,观察组较对照组改善情况更优,但无显著性差异;其中对照组较观察组在糖化血红蛋白值、空腹血糖值上的比较中无显著差异.结论:门冬胰岛素联合地特胰岛素较生物合成人胰岛素注射液R强化治疗2型糖尿病患者与疗效接近,但起效迅速,持续时间久,低血糖反应少,胰岛素用量低.     

短期胰岛素泵强化治疗糖尿病的临床疗效观察

目的 观察比较短期应用胰岛素泵连续皮下输注(CSII)和多次皮下胰岛素注射治疗(MSII)糖尿病患者的疗效.方法 156例糖尿病患者随机分为CSII组和MSII组,分析比较两组血糖控制达标所需时间、胰岛素量及低血糖的发生率.结果 CSII组血糖达标所需时间、胰岛索量、低血糖发生率明显低于MSII组,差异具有统计学意义(P<0.01).结论 短期胰岛索泵强化治疗能较好模拟胰岛素分泌的生理节律,更快、更有效地控制高血糖,明显缩短血糖达标所需时间,减少血糖波动和低血糖的发生.     

大剂量胰岛素联合西格列汀对老年2 型糖尿病患者的疗效

目的:研究大剂量胰岛素联合西格列汀对老年2型糖尿病患者的疗效。方法:选择2012年1月~2015年12月在我院进行诊治的老年2型糖尿病患者82例,随机分为两组,观察组采用大剂量胰岛素联合西格列汀治疗,对照组采用大剂量胰岛素治疗,两组均治疗3个月。比较两组治疗前后的甘油三酯、总胆固醇、低密度脂蛋白和高密度脂蛋白水平,餐后2 h血糖、空腹血糖、糖化血红蛋白,胰岛素抵抗指数、胰岛素分泌指数、每日胰岛素总量和低血糖发生次数。结果:对照组治疗前后的血脂水平无明显差异(P0.05),观察组治疗后的甘油三酯、总胆固醇和低密度脂蛋白明显降低(P0.05),高密度脂蛋白明显升高(P0.05);治疗后,两组的餐后2 h血糖、空腹血糖、糖化血红蛋白均明显降低(P0.05),且观察组降低更为明显(P0.05);对照组治疗前后的胰岛素抵抗指数、胰岛素分泌指数和每日胰岛素总量均无明显差异(P0.05),观察组治疗后的胰岛素抵抗指数和每日胰岛素总量均明显降低(P0.05),胰岛素分泌指数明显升高(P0.05);两组治疗前后低血糖发生次数和身体质量指数均无明显差异(P0.05)。结论:大剂量胰岛素联合西格列汀能有效控制老年2型糖尿病患者的血糖水平,改善胰岛β细胞功能,减少胰岛素用量,是一种安全有效的治疗方法。     

甘精胰岛素联用瑞格列奈治疗初诊2型糖尿病的疗效研究

目的:通过甘精胰岛素联用瑞格列奈与预混人工合成胰岛素(诺和灵30R)治疗初诊2型糖尿病患者的比较,探讨其疗效与安全性.方法:将初诊2型糖尿病患者随机分为甘精胰岛素+瑞格列奈组(A组)和诺和灵30R组(B组),根据血糖情况调整用药剂量.治疗12周后,比较两组的空腹血糖、餐后2小时血糖、糖化血红蛋白(HbA1c)、体重指数(BMI)和低血糖发生率.结果:A组低血糖事件明显少于B组,在餐后2小时血糖方面也优于B组,差异有统计学意义(P<0.05);在空腹血糖、HbA1c和BMI方面差异无统计学意义(p0.05).结论:甘精胰岛素与瑞格列奈联用对于初诊2型糖尿病患者,其血糖控制满意,餐后血糖更加平稳,低血糖发生率低,是一种针对初诊2型糖尿病患者安全、有效、方便的治疗方案.     

门冬胰岛素与人普通胰岛素及胰岛素泵在2 型糖尿病患者围手术期 的疗效比较

目的:探讨速效胰岛素类似物(门冬胰岛素,诺和锐)与人普通胰岛素(诺和灵R)及胰岛素泵在2型糖尿病(T2DM)围手术期治疗中的有效性和安全性。方法:158例围手术期T2DM患者随机分为胰岛素泵输注门冬胰岛素治疗CSII组52例,门冬胰岛素多次皮下注射治疗MSII(A)组56例,人普通胰岛素多次皮下注射治疗MSII(B)组50例。观察各组患者治疗前后空腹和餐后2h血糖变化、血糖达标时间、胰岛素用量、低血糖发生率及术后并发症发生率。结果:3组治疗后血糖均明显低于治疗前,CSII组治疗后血糖低于MSII(A)组(P<0.05),MSII(A)组治疗后血糖低于MSII(B)组(P<0.05);术后并发症CSII组低于MSII(A)组(P<0.05),MSII(A)组低于MSII(B)组(P<0.05)。结论:门冬胰岛素对T2DM围手术期血糖控制有较好的有效性、安全性和顺应性,胰岛素泵是2型糖尿病患者围手术期胰岛素输注的最佳模式。     

胰岛素不同给药方式治疗1型糖尿病临床疗效观察

目的：探讨胰岛素采用不同的给药方式对1型糖尿病患者临床治疗效果的影响。方法：回顾性分析了于2010．06．2012．10入住我院的60例1型糖尿病患者的临床资料,采用两种不同的给药方式：胰岛素泵持续皮下注射和胰岛素分次皮下注射,并检测以下指标以评判治疗方式优劣：血糖达标时间、胰岛素用量、低血糖发生次数。结果：（1）两组不同给药方式患者的血糖达标时间存在显著的统计学差异（P〈0．05）,两组患者的胰岛素用量也存在显著的统计学差异（P〈0．05）。（2）两组不同给药方式患者的低血糖发生次数之间存在显著的统计学差异（P〈0．01）。结论：胰岛素泵持续皮下注射是1型糖尿病患者血糖控制的最佳治疗方式。     

疏肝化瘀通络法对初诊2型糖尿病患者血糖及胰岛β细胞功能的影响

目的:观察中医疏肝化瘀通络法治疗初诊2型糖尿病患者的胰岛β细胞及胰岛素抵抗的影响.方法:将60例符合入选标准的新诊断的2型糖尿病患者,随机分组2组(治疗组与对照组),2组在饮食控制和运动治疗方案的基础上,对照组给予口服二甲双胍片;治疗组在口服二甲双胍的基础上加服以疏肝化瘀通络法组方的中药方剂,两组治疗疗程均为12周.观察治疗前后患者血糖、糖化血红蛋白、胰岛素敏感性及胰岛β细胞功能的影响并记录低血糖及其它不良反应.结果:与治疗前相比,二甲双胍+疏肝化瘀通络方治疗后患者空腹、餐后2 h血糖均下降(P＜0.05);HbA1C下降(P＜0.05);体重指数(BMI)下降(P＜0.05);胰岛素敏感性增加;未观察到低血糖或其它不良反应.结论:疏肝化瘀通络法对初诊2型糖尿病患者有良好的临床疗效.可望为2型糖尿病的中西治疗提供新方法,值得进一步深入研究.     

胰岛素不同给药方式对妊娠期糖尿病患者围手术期血糖控制的效果研究

目的:研究胰岛素不同给药方式对妊娠期糖尿病患者围手术期血糖控制的效果与安全性。方法:选择2013年11月～2016年11月于我院接受治疗的92例妊娠期糖尿病患者,所有患者按随机数字表法分为对照组和研究组,每组46例。对照组围手术期予以皮下注射胰岛素治疗,研究组围手术期予以胰岛素泵治疗。比较两组空腹血糖(FBG),餐后2 h血糖(2hPBG),血糖达标情况,抗生素使用情况,切口愈合情况、住院时间及并发症的发生情况。结果:治疗后12 h、24 h及36 h,两组FBG、2hPBG水平均较治疗前显著下降,且研究组以上指标均低于对照组(P0.05)。研究组血糖达标、抗生素使用、切口愈合及住院时间均明显短于对照组(P0.05)。两组均有低血糖、切口感染发生,研究组并发症发生率低于对照组(P0.05)。结论:胰岛素泵输注胰岛素对妊娠期糖尿病患者围手术血糖的控制效果明显优于皮下注射胰岛素,且其安全性更高。     

Basal and Bolus Insulin Requirements in Children,Adolescents, and Young Adults with type 1 Diabetes Mellitus on Continuous Subcutaneous Insulin Infusion (csii): Effects of age and Puberty

ObjectiveGuidelines for insulin dosing, including the insulin to carbohydrate ratio (I/C), insulin sensitivity factor (ISF), and basal/bolus ratio guidelines, have been well established for adults with type 1 diabetes mellitus (T1DM). However, clinical experience suggests that these guidelines are not appropriate for children. The purpose of this study was to determine the continuous subcutaneous insulin infusion (CSII) settings in children with T1DM at different ages and stages of puberty.MethodsA total of 154 patients data between the ages of 3 and 21 years with well-controlled T1DM according to American Diabetes Association guidelines were reviewed. Only patients on CSII who were not in the honeymoon period were included.ResultsPatients were divided into 8 groups according to age, gender, and/or pubertal stage. Insulin requirements increased with puberty in both sexes (0.69, 0.97, and 0.90 U/kg/day in children <7 years of age, midpubertal girls, and late-pubertal boys, respectively). Basal insulin requirement was lowest in the youngest group (34%; P<.01). The youngest group had the lowest I/C prediction factor (PF) (mean, 315.7 ± 79.4; P<.01 with all groups), and the ISF-PF was higher than that of the oldest group (mean, 2,588.3 ± 1,101.8; P<.01).ConclusionCSII dose calculations vary with age and pubertal status in children with T1DM. These differences must be considered when calculating CSII dosing, especially for younger children. (Endocr Pract. 2013; 19:805-811)     

Bacterial strains colonizing subcutaneous catheters of personal insulin pumps

Continuous subcutaneous insulin infusion (CSII) is a commonly used, safe intensive insulin therapy method effective in maintaining normoglycaemia. The disadvantage of CSII are skin infections of the catheter injection site. The aim of the study was to gain insight on the colonization of subcutaneous insulin pump catheters by skin flora and to investigate the correlation between Staphylococcus aureus carrier state (presence in the nose), its presence on the skin and catheter. 141 catheters obtained from 94 children with T1DM and CSII were examined using the semi quantitative culture technique of Maki. The result was positive in 34 examinations (24.1%) in 30 children (31.9%). Most often coagulase negative staphylococci were isolated (30), mainly Staphylococcus epidermidis, 1/3 of the staphylococci were methicillin resistant. S. aureus was detected in 7 examinations in 6 children. S. aureus carrier state was proved in 31.9% of all examined patients, more often in children with a positive catheter culture (41.4%), there were no MRSA. No correlation between S. aureus carrier state and catheter colonization was shown. Statistically significant correlations between: coagulase negative staphylococci presence, including the methicillin resistant strains, on the skin and on the catheter surface (p< 0.0001); glycosylated hemoglobin (HbA1c) and bacteria catheter colonization (p = 0.0335) were observed. Subcutaneous catheter colonization by microorganisms often occurs in CSII. Microorganisms found on the skin are the most frequent cause of the subcutaneous catheter infection.     

Evaluation of Lipohypertrophy in Patients With Type 1 Diabetes Mellitus on Multiple Daily Insulin Injections or Continuous Subcutaneous Insulin Infusion

ObjectiveTo determine lipohypertrophy (LH) in patients with type 1 diabetes mellitus (T1DM) on multiple daily insulin injections (MDII) or continuous subcutaneous insulin infusion (CSII) and to reveal the factors associated with the development and severity of LH.MethodsSixty-six patients with T1DM treated with MDII (n = 35, 53%) or CSII (n = 31, 47%) for at least 1 year were included. LH localizations were detected with palpation and ultrasonography (USG).ResultsThe LH detection rate with USG was significantly higher than that by palpation in the whole group (P < .001). The LH was detected with USG in 30 (85.7%) patients in the MDII group and 22 (71.0%) patients in the CSII group (P = .144). Advanced LH was detected in 13 (37.1%) of the patients treated with MDII and in 3 (9.7%) of the patients treated with CSII. LH was more severe in the MDII group than in the CSII group (P = .013). Diabetes duration and length of infusion set use were significantly longer and body mass index, hypoglycemia, and complication rates were higher in patients with LH than those in patients without LH (P < .05). A positive correlation was found between LH severity and HbA1C and insulin dose (P < .05, for both). MDII as insulin administration method, incorrect rotation, and a history of ketosis were found to be the most related factors with LH severity in a multiple linear regression analysis (P < .05).ConclusionUSG might be an effective approach for detecting and evaluating the severity of LH. MDII might cause more severe LH than CSII in patients with T1DM. In this study, LH was found to be associated mostly with incorrect rotation technique and a history of ketosis.     

Type 1 Diabetes Mellitus and Lipohypertrophy - Impact of the Intervention on Glycemic Control via Patient’s Examination and Retraining on Change of Infusion Set

ObjectiveLipohypertrophy (LH) is a common complication of insulin therapy in type 1 diabetes mellitus (T1DM). We examined whether an intervention consisting of LH assessment and retraining on insulin infusion set use improves glycemic control on subcutaneous insulin infusion (CSII) in patients with T1DM.MethodsThe intervention was conducted in 79 consecutive patients with T1DM. Data on glucose levels, glycated hemoglobin (HbA1c), and insulin doses were collected at baseline and after a median of 22 weeks (20-31.75 weeks).ResultsA total of 46 patients with T1DM (23 [50%] women) participating in the follow-up were characterized by a median age of 29 years (25-33.8 years), body mass index of 24.6 ± 3.3 kg/m², T1DM duration of 16.5 years (8.3-20 years), and subcutaneous insulin infusion duration of 7 years (4-10.8 years). Patients’ median HbA1c fell from 7.4% (6.7%-8.2%) to 7.05% (6.4%-7.6%) (P < .001), daily insulin dose/kg decreased (0.7 ± 0.20 vs 0.68 ± 0.15 IU/kg; P = .017) together with the total daily insulin dose (50.3 [40.5-62.7] vs 47.6 [39.8-62.1] IU; P = .019]. Furthermore, the percentage of basal insulin dose increased (43.0% [36-50] vs 44.0% [39.0-50.0]; P = .010], whereas the percentage of bolus dose decreased (57% [50-64] vs 56% [50-61], P = .010).ConclusionsThe structured LH-related intervention in patients with T1DM on insulin pumps resulted in better glycemic control and a decrease in total daily insulin dose.     

Effects of short-term continuous subcutaneous insulin infusion on fasting plasma fibroblast growth factor-21 levels in patients with newly diagnosed type 2 diabetes mellitus

Background

To investigate the effects of short-term continuous subcutaneous insulin infusion (CSII) on plasma fibroblast growth factor-21 (FGF-21) levels in patients with newly diagnosed type 2 diabetes mellitus (nT2DM).

Method

Sixty-eight patients with nT2DM (nT2DM group), and 52 gender-, age- and body mass index (BMI) -matched normal glucose tolerance (NGT group) controls participated in the study. 30 nT2DM patients with FBG≥14.0 mmol/L were treated with CSII for 2 weeks, and were underwent a euglycemic–hyperinsulinemic clamp pre- and post-treatment. Plasma FGF-21 concentrations were measured with a commercial ELISA kit. The relationship between plasma FGF-21 levels and metabolic parameters was also analyzed.

Results

Fasting plasma FGF-21 levels were higher in the nT2DM group than in NGT groups (1.60±0.08 vs. 1.13±0.26 µg/L, P<0.01). In nT2DM patients, fasting plasma FGF-21 concentrations were significantly decreased after CSII treatment for 2 weeks (1.60±0.08 vs.1.30±0.05 µg/L, P<0.05), accompanied by a significant increase in the whole body glucose uptake (M value) and blood glucose control. The changes in plasma FGF-21 levels (ΔFGF-21) were positively associated with the amelioration of insulin resistance shown by the changes in M value.

Conclusion

Plasma FGF-21 level is associated with whole body insulin sensitivity and significantly reduced following short-term CSII treatment.     

Superiority of insulin analogues versus human insulin in the treatment of diabetes mellitus

The modern goals of insulin replacement in Type 1 and Type 2 diabetes mellitus (T1, T2DM) are A1C <6.5% long-term, and prevention of hypoglycaemia (blood glucose, BG <70 mg/dl). In addition to appropriate education and motivation of diabetic subjects, the use of rapid- and long-acting insulin analogues, is critical to achieve these goals. The benefits of rapid-acting analogues (lispro, aspart and glulisine have similar pharmacodynamic effects) compared with non-modified human regular insulin, are: (a) lower 1- and 2-h post-prandial blood glucose; (b) lower risk of late post-prandial hypoglycaemia (and therefore lower BG variability); (c) better quality of life (greater flexibility in timing and dosing of insulin). In T1DM, rapid-acting analogues improve A1C only by the extent to which replacement of basal insulin is optimized at the same time, either by multiple daily NPH administrations, or continuous subcutaneous insulin infusion (CSII), or use of the long-acting insulin analogues glargine or detemir. In T2DM, rapid-acting analogues reduce post-prandial hyperglycaemia more than human regular insulin, but systematic studies are needed to examine the effects on A1C. The benefits of long-acting insulin analogues glargine and detemir vs. NPH, are: (1) lower fasting BG combined with lower risk of hypoglycaemia in the interprandial state (night); (2) lower variability of BG. Glargine and detemir differ in terms of potency and duration of action. Detemir should be given twice daily in the large majority of people with T1DM, and in a large percentage of subjects with T2DM as well, usually at doses greater vs those of the once daily glargine. However, when used appropriately for individual pharmacokinetics and pharmacodynamics, glargine and detemir result into similar effects on BG, risk of hypoglycaemia and A1C. Rapid- and long-acting insulin analogues should always be combined in the treatment of T1 and T2DM.     

AdipoRon对2型糖尿病小鼠肾脏损伤的干预作用

目的：研究脂联素受体激动剂（AdipoRon）对2型糖尿病小鼠肾脏损伤的干预作用。方法：将40只SPF级雄性C57/BL6小鼠随机分为正常对照组（n=10）和实验组（n=30）：实验组给予高糖、高脂饲料喂养,联合腹腔注射小剂量链脲佐菌素（STZ）建立2型糖尿病（T2DM）小鼠模型,再随机分为3组（n=10）：模型对照（DM）组、低剂量AdipoRon治疗（DM+L）组及高剂量AdipoRon治疗（DM+H）组。检测血清中葡萄糖含量的变化;采用酶联免疫法检测小鼠血清中胰岛素受体（INSR）、胰岛素受体底物-1（IRS-1）以及肿瘤坏死因子-α（TNF-α）的蛋白质含量;HE染色镜下观察肾组织形态学变化;实时荧光定量PCR法检测肾组织胰岛素促进因子-1（PDX-1）和胰岛素（insulin）mRNA的表达;Western blot检测肾组织内磷酸化胰岛素受体底物-1（p-IRS-1）蛋白质;ELISA试剂盒检测小鼠血胰岛素含量。结果：病理学检查表明,AdipoRon可减轻2型糖尿病所致小鼠肾脏损伤。与DM组小鼠比较,DM+H组和DM+L组小鼠血糖、TNF-α水平均显著降低（P<0.05）,INSR、IRS-1和p-IRS-1表达显著上升,PDX-1和insulin mRNA表达显著上升（P<0.05,P<0.01）。结论：给予AdipoRon治疗的小鼠血糖和血清TNF-α水平显著降低,INSR,IRS-1和p-IRS-1蛋白质含量,PDX-1和insulin mRNA表达均显著上升,表明AdipoRon对2型糖尿病小鼠肾脏损伤有一定的干预作用。     

Use of Insulin Pump Therapy in Patients with Type 2 Diabetes After Failure of Multiple Daily Injections

ObjectiveTo determine the effectiveness of insulin pump use (continuous subcutaneous insulin infusion; CSII) in patients with type 2 diabetes (DM2) who have failed multiple daily injection (MDI) therapy.MethodsIn this retrospective study, charts of patients with DM2 who were started on CSII after failure of MDI were reviewed. Patients were categorized as primarily manual (fixed) bolus users or calculated (using pump software) bolus users. The change in hemoglobin A1c (HbA1c), weight, and basal insulin dose from baseline to 6 months was determined.ResultsFifty-seven patients (20 men and 37 women) ranging in age from 13 to 71 were identified in the study. A significant reduction in HbA1c was observed from 8.75 to 7.69% (P<.001). There was an increase in body mass index (BMI) from a mean of 36.53 to a mean of 37.21. A decrease in basal insulin requirement per kilogram of weight (−0.10 U/kg) was noted (P = .03). Seven patients using U-500 insulin in the pump also had a significant decrease in HbA1C of 1.1 % (P<.001), along with a 0.071 U/kg drop in basal insulin requirements (P<.001). When comparing calculated bolus users to manual bolus users, there was no difference in HbA1C improvement (P = .58).ConclusionWe found that CSII improves glucose control in patients with DM2 who have failed MDI despite a decrease in overall insulin requirements. This includes patients with severe insulin resistance using U-500 insulin. Use of frequent bolus adjustment incorporating carbohydrate counting and current glucose level does not appear to be required for this benefit. (Endocr Pract. 2013;19: 9-13)