糖尿病患者血糖控制不佳时治疗方案选择的参考指标

目的探讨糖尿病患者血糖控制不佳时治疗方案选择的参考指标.方法选择血糖控制不佳的312例Ⅱ型糖尿病患者,入院后行胰岛素强化降糖治疗,血糖稳定后检测胰岛功能,空腹C肽≥1 ng/m L的患者改为口服促进胰岛素分泌类药物联合基础胰岛素治疗(方案1),空腹C肽1 ng/m L的患者继续胰岛素强化降糖治疗,4次/d(方案2);接受方案1的患者连续治疗7 d后若空腹血糖和餐后2 h血糖未达标,则改行方案2.比较两组患者性别、年龄、体质量指数、糖尿病病程、空腹血糖、糖化血红蛋白、餐后2 h血糖、空腹C肽、餐后2 h C肽水平.结果两组患者性别、年龄、糖尿病病程之间差异均无统计学意义(P0.05);方案1组患者体质量指数、空腹C肽、餐后2 h C肽、Δ空腹C肽明显高于方案2组,空腹血糖、餐后2 h血糖、糖化血红蛋白明显低于方案2组,差异均具有统计学意义(P0.05).经胰岛素强化治疗血糖稳定后分组,两组患者胰岛素剂量、低血糖发生率、空腹血糖达标率、餐后2 h血糖达标率之间差异无统计学意义(P0.05);治疗30 d门诊随访,方案1组胰岛素剂量、低血糖发生率明显低于方案2组,空腹血糖达标率、餐后2 h血糖达标率明显高于方案2组,差异具有统计学意义(P0.05).二元逐步Logistic回归分析显示:体质量指数、Δ空腹C肽为选择方案1的独立影响因素.结论糖尿病患者血糖控制不佳时,体质量指数、餐后2 h C肽可作为降糖方案选择的预测指标.

Reference Index of Treatment Options for Patients with Poor Blood Glucose Control

Objective Explore the reference index of treatment options for diabetic patients with poor glucose control.Method 312 cases of poor glycemic control type 2 diabetes mellitus were selected.After admission, insulin intensive hypoglycemic treatment was performed and the function of islets was detected after glucose stability.Patients with fasting C peptide≥1 ng/mL were changed to oral administration of insulin secreting drugs combined with basal insulin therapy (plan 1).Patients with fasting C peptide <1 ng/mL continued to be treated with insulin intensive hypoglycemic treatment,4 times/d (plan 2);After patients in plan 1 were treated 7 d,if fasting blood glucose and postprandial 2 h blood glucose were not up to standard,then plan 2 was treated. Compared the sex,age,body mass index,diabetes course,fasting blood glucose,glycated hemoglobin,postprandial 2 h blood glucose,fasting C peptide,and postprandial 2 h C peptide between the two groups.Results The body mass index,fasting C peptide,postprandial 2 h C peptide and delta fasting C peptide in plan 1 were significantly higher than those of plan 2.The fasting blood glucose,postprandial 2 h blood glucose and glycated hemoglobin were significantly lower than those in plan 2,the difference was statistically significant (P<0.05).There was no significant difference in insulin dose,hypoglycemia,fasting blood glucose level and 2 h blood glucose standard rate between the two groups (P>0. 05). In the treatment of 30 d follow-up,the rate of insulin dose and hypoglycemia of plan 1 was significantly lower than that of plan 2,the rate of fasting blood glucose level and the rate of 2 h blood glucose after meal were significantly higher,the difference was statistically significant meaning (P<0.05).Two stepwise Logistic regression analysis showed that body mass index and delta fasting C peptide were independent factors of selection 1.Conclusion Diabetic patients with poor glucose control,the body mass index and postprandial 2 h C peptide proliferation can be used as the predictors.