Optimization of evening insulin dose in patients using the short-acting insulin analog lispro
Optimization of evening insulin dose in patients using the short-acting insulin analog lispro
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DOI：
10.2337/diacare.21.7.1162
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发表时间：
1998-07-01
期刊：
影响因子：
16.2
通讯作者：
Home, PD
中科院分区：
文献类型：
--
作者：
Ahmed, ABE;Mallias, J;Home, PD
目的-一项三向、交叉、开放标签、随机研究，旨在比较晚间餐前赖脯胰岛素剂量减少 20% 且睡前基础 NPH 剂量增加 25% 时，或当晚餐前基础 NPH 剂量调整至 1800 时，与标准餐前人常规胰岛素和标准餐前胰岛素的对照组相比，晚上和夜间 (1800-0800) 的血糖控制情况。睡前 NPH 胰岛素。 研究设计和方法 - 总共 13 名使用餐前加基础胰岛素方案的 1 型糖尿病患者在三天内进行了研究，每个研究日的同一时间进食相同的膳食和零食。在对照研究日，患者在晚餐前接受人常规胰岛素，并在睡前接受常规剂量的 NPH。另一天，晚餐前服用赖脯胰岛素，剂量减少 20%，睡前服用 NPH，剂量为常用剂量的 125%。在第三种方案中，赖脯胰岛素和 NPH 在晚餐前按常规剂量单独注射。以随机顺序测试三种方案。结果-与人常规胰岛素相比，减少剂量的赖脯胰岛素后餐后（1800-2200）血糖浓度较低（6.0 +/- 0.3 [SEM] vs. 7.4 +/- 0.3 mmol/l，P < 0.05）。与标准胰岛素相比，使用增加剂量的 NPH 的赖脯胰岛素后，夜间 (2400-0400) 血糖浓度没有差异（8.6 +/- 0.3 与 9.2 +/- 0.3 mmol/l，NS），早餐前浓度也没有变化（7.7 +/- 0.9 与 8.7 +/- 0.8 mmol/l）。相比之下，与标准人胰岛素相比，晚餐常用剂量赖脯胰岛素加晚餐常用剂量 NPH 的夜间血糖浓度 (10.0 +/- 0.3 mmol/l，P < 0.05) 和空腹血糖浓度 (10.8 +/- 0.6 mmol/l，P < 0.05) 均显着高于标准人胰岛素。夜间低血糖（血糖
OBJECTIVE-A three-way, crossover, open-label, randomized study was designed to compare the evening and night (1800-0800) glycemic control when the evening premeal lispro dose was reduced by 20% and the bedtime basal NPH dose increased by 25%, or when the basal NPH dose was mo;ed to before dinner at 1800, compared with the control arm on standard premeal human regular insulin and pre-bedtime NPH insulin.RESEARCH DESIGN AND METHODS-A total of 13 type 1 diabetic patients who use a premeal plus basal insulin regimen were studied on three separate days, with identical meals and snacks at the same times on each study day On the control study day, patients received human regular insulin before dinner and NPH at bedtime in their usual doses. On another day, lispro was given before dinner with a dose reduction of 20%, and NPH at bedtime at 125% of usual dose. In the third regimen, the lispro and NPH were administered together in their usual dose before the evening meal by separate injections. The three regimens were tested in random order.RESULTS-Postprandial (1800-2200) blood glucose concentrations were lower after reduced-dose lispro compared with human regular insulin (6.0 +/- 0.3 [SEM] vs. 7.4 +/- 0.3 mmol/l, P < 0.05). Nighttime (2400-0400) blood glucose concentrations were not different (8.6 +/- 0.3 vs. 9.2 +/- 0.3 mmol/l, NS), and prebreakfast concentrations were also unchanged (7.7 +/- 0.9 vs. 8.7 +/- 0.8 mmol/l) after lispro with increased-dose NPH compared with standard insulin. By contrast, both nighttime (10.0 +/- 0.3 mmol/l, P < 0.05) and fasting glucose concentrations (10.8 +/- 0.6 mmol/l, P < 0.05) were significantly higher with dinnertime usual-dose lispro plus dinnertime usual-dose NPH compared with standard human insulin. Hypoglycemia at night (blood glucose