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分为门冬胰岛素 30 TID (n=220)或门冬胰 [3] Dalal MR, Grabner M, Bonine N,
岛素 30 BID (n=217)治疗,其中69%的受 et al. Are patients on basal insulin
试者来自中国大陆,超过78%的患者既往 attaining glycemic targets?
使用甘精胰岛素。治疗24周后,门冬胰岛 Characteristics and goal achievement of
素30 BID方案和TID方案均能进一步降低 patients with type 2 diabetes mellitus
HbA ( 较 基 线 降 幅 1.6% vs 1.7%,P = treated with basal insulin and physician-
1c
0.26),两组低血糖发生率相似、严重低 perceived barriers to achieving glycemic
血糖发生率低、安全性及耐受性均良好。 targets [J].Diabetes Res Clin Pract, 2016,
121:17-26.
讨论
基础胰岛素方案血糖控制不达标时可 [4] Mauricio D, Meneghini L, Seufert
转为基础胰岛素加1~3次餐时胰岛素方 J, et al. Glycaemic control and
案、预混胰岛素每日多次注射方案或CSII hypoglycaemia burden in patients with
方案 [14] 。Meta分析 [15] 显示,基础胰岛素 type 2 diabetes initiating basal insulin in
加1~3次餐时胰岛素与预混胰岛素每日多 Europe and the USA [J]. Diabetes Obes
次注射的HbA 降幅、低血糖发生率均相 Metab, 2017,19(8):1155-1164.
1c
似。但基础-餐时胰岛素方案较为复杂,容 [5] Holman RR, Farmer AJ, Davies
易出现遗漏注射或用药错误 [16-17] 。4200研 MJ,et al. Three-year efficacy of complex
究显示基础胰岛素方案血糖控制不达标转 insulin regimens in type 2 diabetes [J].N
为门冬胰岛素30 BID或TID的降糖疗效及 Engl J Med, 2009,361(18):1736-47.
安全性相似,临床医生可参考患者个体化 [6] Home PD, Dain MP, Freemantle
特点,如果HbA 始终不达标、午餐饭量 N,et al.Four-year evolution of insulin
1c
较大或午餐后餐后血糖较高考虑门冬胰岛 regimens, glycaemic control,
素30 TID治疗。4200研究为中国基础胰岛 hypoglycaemia and body weight after
素治疗血糖控制欠佳的T2DM患者转为门 starting insulin therapy in type 2 diabetes
冬胰岛素30增添了新的证据,丰富了基础 across three continents [J]. Diabetes Res
胰岛素失效后进一步优化方案的药物选 Clin Prac, 2015, 108(2):350-9.
择。
[7] Yang W, Ji Q, Zhu D, et al.
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