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目的探讨磺脲类药物继发性治疗失效的2型糖尿病患者加用甘精胰岛素(IG)或中效精蛋白人胰岛素(NPH)后的疗效及胰岛B细胞功能的变化。方法2004-05—2004-11对上海市第一人民医院52例磺脲类药物继发性失效的糖尿病患者,改用格列吡嗪控释片,并分别睡前注射IG(20例)或NPH(32例),观察16周内多点空腹血糖变化及16周前后HbA1c、餐后血糖、空腹和餐后C肽。结果两组均有显著的降血糖效果,且疗效、所用剂量相近,但IG组低血糖事件明显少于NPH组,且治疗后血清C肽水平明显升高,而NPH组C肽无变化。结论睡前注射甘精胰岛素或中效人胰岛素对磺脲类继发性失效者均有较高的达标率,联用甘精胰岛素可改善胰岛B细胞功能。
Objective To investigate the curative effect and the changes of islet B cell function in patients with type 2 diabetes mellitus after secondary failure of sulfonylurea treated with insulin glargine (IG) or moderately-spirited human insulin (NPH). Methods A total of 52 patients with secondary failure of sulfonylurea in Shanghai First People ’s Hospital were treated with glipizide - controlled release tablets and IG (20 cases) or NPH (32 cases). The changes of fasting blood glucose and HbA1c, postprandial blood glucose, fasting and postprandial C-peptide were observed before and after 16 weeks. Results Both groups had significant hypoglycemic effect. The curative effect and dose were similar. However, the incidence of hypoglycemia in IG group was significantly lower than that in NPH group. The level of serum C-peptide was significantly increased after treatment, while the C peptide in NPH group was unchanged. Conclusion Before going to bed, injection of glargine or moderately effective human insulin has a higher compliance rate for secondary failure of sulfonylureas. Combined with glargine, it can improve the function of islet B cells.