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目的探讨2型糖尿病肥胖患者在口服降糖药继发失效的情况下启用胰岛素治疗方案的选择。方法选择2009年1月2010年12月间40例口服降糖药失效的2型糖尿病肥胖患者,随机分为两组,每组20例。A组原口服药不变,睡前联用长效胰岛素(商品名:来得时)治疗,B组停用口服药,于早晚餐前使用预混胰岛素(商品名:诺和灵30R),治疗共3个月,分别于治疗前后观察空腹血糖、餐后2h血糖、糖化血红蛋白、血脂、血压、体质量指数的变化,记录低血糖发生次数,并填写问卷调查表,评估患者对治疗方案的满意度和接受度。结果两个组治疗后空腹血糖、餐后2h血糖、糖化血红蛋白均较治疗前明显下降(P<0.01),而血脂、血压变化不大;但B组体质量指数有轻微升高(P>0.05),且每日胰岛素用量较A组更大(P<0.01),低血糖反应更多(P<0.05),满意度和接受度不如A组高(P>0.05)。结论对2型糖尿病肥胖患者在口服降糖药继发失效的情况下启用胰岛素治疗,选用口服降糖药联合基础胰岛素的治疗方案具有作用佳、安全性好,体重增加不明显,患者依从性更高的特点。
Objective To investigate the options of insulin therapy in obese type 2 diabetic patients with secondary failure of oral hypoglycemic agents. Methods Forty obese patients with type 2 diabetes mellitus who failed oral administration of hypoglycemic agents during January 2009 and December 2010 were randomly divided into two groups (20 in each group). A group of the original oral medication unchanged, bedtime combined with long-acting insulin (product name: too late) treatment, B group discontinued oral medication, in the early dinner before use of premixed insulin (Novolin 30R) The changes of fasting blood glucose, 2h postprandial blood glucose, glycosylated hemoglobin, blood lipid, blood pressure and body mass index were observed 3 months after treatment. The incidence of hypoglycemia was recorded and the questionnaire was filled in to evaluate the patients’ satisfaction with the treatment plan And acceptance. Results The fasting blood glucose, 2h postprandial blood glucose and glycosylated hemoglobin in both groups were significantly lower than those before treatment (P <0.01), while the blood lipid and blood pressure did not change much in both groups. However, the body mass index of group B increased slightly (P> 0.05 (P <0.01). The hypoglycemic reaction was more frequent (P <0.05), and the satisfaction and acceptability were not as high as those in group A (P> 0.05). Conclusions Insulin treatment can be activated in type 2 diabetic patients with obesity due to secondary failure of oral hypoglycemic agents. Treatment with oral hypoglycemic agents combined with basal insulin has good effect, good safety, no obvious weight gain and more patient compliance High characteristics.