Comparison of Inpatient Insulin Regimens with Detemir plus Aspart Versus Neutral Protamine Hagedorn plus Regular in Medical Patients with Type 2 Diabetes
Comparison of Inpatient Insulin Regimens with Detemir plus Aspart Versus Neutral Protamine Hagedorn plus Regular in Medical Patients with Type 2 Diabetes
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DOI：
10.1210/jc.2008-1441
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发表时间：
2009-02-01
影响因子：
5.8
通讯作者：
Baldwin, David
中科院分区：
文献类型：
--
作者：
Umpierrez, Guillermo E.;Hor, Tiffany;Baldwin, David
背景资料：缺乏对2型糖尿病住院患者使用基础餐时胰岛素类似物与使用人胰岛素的分流混合方案进行比较的研究。在一项多中心对照试验中，我们将130名血糖（BG）在140 - 400 mg/dl之间的非手术患者随机分为两组，一组接受地特胰岛素每日一次和餐前门冬胰岛素（n = 67），另一组接受中性鱼精蛋白哈格多恩（NPH）和常规胰岛素每日两次（n = 63）。对于BG 140 - 200 mg/dl，胰岛素剂量起始为0.4 U/kg. d，对于BG 201 - 400 mg/dl，胰岛素剂量起始为0.5 U/kg. d。主要研究结果包括治疗组间平均每日BG水平和低血糖事件频率的差异。两组的血糖控制改善相似，平均每日BG分别为228 +/-54和223 +/-58 mg/dl地特胰岛素/门冬胰岛素组和NPH/常规胰岛素组第1天后的平均每日BG水平分别为160 +/-38和158 +/-51 mg/dl（P = 0.61）（P = 0.80）。地特胰岛素/门冬胰岛素组和NPH/常规胰岛素组分别有45%和48%的患者达到餐前血糖低于140 mg/dl的目标（P = 0.86）。治疗期间，22名患者地特胰岛素/门冬胰岛素组为32.8%，NPH/常规组中25.4%的患者至少发生过一次低血糖发作住院期间血糖<60 mg/dl（P = 0.34）。结论：基础治疗/地特胰岛素每日一次和门冬胰岛素餐前推注方案的血糖控制效果相当，与分开给药相比，低血糖发生频率无差异。NPH与常规胰岛素混合方案治疗2型糖尿病的临床观察（临床内分泌代谢杂志94：564 - 569，2009）
Background: Studies comparing the use of basal bolus with insulin analogs vs. split-mixed regimens with human insulins in hospitalized patients with type 2 diabetes are lacking.Research Design and Methods: In a controlled multicenter trial, we randomized 130 nonsurgical patients with blood glucose (BG) between 140 and 400 mg/dl to receive detemir once daily and aspart before meals (n = 67) or neutral protamine Hagedorn (NPH) and regular insulin twice daily (n = 63). Insulin dose was started at 0.4 U/kg.d for BG between 140 and 200 mg/dl or 0.5 U/kg.d for BG 201-400 mg/dl. Major study outcomes included differences in mean daily BG levels and frequency of hypoglycemic events between treatment groups.Results: Glycemic control improved similarly in both groups from a mean daily BG of 228 +/- 54 and 223 +/- 58 mg/dl (P = 0.61) to a mean daily BG level after the first day of 160 +/- 38 and 158 +/- 51 mg/dl in the detemir/aspart and NPH/regular insulin groups, respectively (P = 0.80). A BG target below 140 mg/dl before meals was achieved in 45% of patients in the detemir/aspart group and 48% in the NPH/regular group (P = 0.86). During treatment, 22 patients (32.8%) in the detemir/aspart group and 16 patients (25.4%) in the NPH/regular group had at least one episode of hypoglycemia (BG < 60 mg/dl) during the hospital stay (P = 0.34).Conclusions: Treatment with basal/bolus regimen with detemir once daily and aspart before meals results in equivalent glycemic control and no differences in the frequency of hypoglycemia compared to a split-mixed regimen of NPH and regular insulin in patients with type 2 diabetes. (J Clin Endocrinol Metab 94: 564-569, 2009)