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目的研究口服降糖药控制不佳的老年肥胖T2DM患者加用甘精胰岛素或中效胰岛素联合应用治疗的有效性和安全性。方法将口服降糖药控制不佳的老年肥胖T2DM患者61例随机分为甘精胰岛素组和中效胰岛素组,治疗期内阿卡波糖和(或)二甲双胍剂量不变,分别加用甘精胰岛素或中效胰岛素每晚睡前注射1次联合治疗,进行12周的观察。结果 (1)两组HbA1c、FPG、2hPG与治疗前比较以及两组间HbA1c、2hPG比较,差异有统计学意义(P<0.05),两组间FPG比较差异无统计学意义(P>0.05);(2)甘精胰岛素组BMI与治疗前比较降低了2.7kg/m2,而中效胰岛素组BMI与治疗前比较基本没有改变;(3)甘精胰岛素组和中效胰岛素组分别有45.2%和73.3%的患者发生症状性低血糖,差异有统计学意义(P<0.05);(4)治疗结束时甘精胰岛素组与中效胰岛素组胰岛素用量分别为(18.7±3.5)U/d和(26.0±3.7)U/d,差异有统计学意义(P<0.05)。结论口服降糖药血糖控制不佳的老年肥胖T2DM患者,在阿卡波糖和(或)二甲双胍基础上加用甘精胰岛素能有效控制血糖,降低低血糖的发生率,并能有效地控制体重。
Objective To study the efficacy and safety of oral administration of insulin glargine or insulin plus insulin in elderly obese T2DM patients with poorly controlled oral hypoglycemic agents. Methods Sixty-one elderly patients with obesity T2DM with poorly controlled oral hypoglycemic agents were randomly divided into insulin glargine group and moderate-acting insulin group. The doses of acarbose and / or metformin remained unchanged during the treatment period, Insulin or insulin injections at bedtime once a night combination therapy, for 12 weeks of observation. Results (1) HbA1c, FPG and 2hPG in two groups had significant difference compared with before treatment and HbA1c and 2hPG between the two groups (P <0.05). There was no significant difference in FPG between the two groups (P> 0.05) ; (2) BMI in insulin glargine group decreased by 2.7 kg / m2 compared with that before treatment, while the BMI in middle-acting insulin group remained basically unchanged before treatment; (3) 45.2% of insulin- And 73.3% patients had symptomatic hypoglycemia, respectively (P <0.05). (4) At the end of treatment, insulin dosage of insulin glargine group and middle-acting insulin group were (18.7 ± 3.5) U / d and (26.0 ± 3.7) U / d, the difference was statistically significant (P <0.05). Conclusion Oral hypoglycemic agents with poorly controlled glycemic control in elderly patients with obesity T2DM plus glargine on the basis of acarbose and / or metformin can effectively control blood glucose, reduce the incidence of hypoglycemia and can effectively control body weight .