本文選題：2型糖尿病 + 超重/肥胖�。� 參考：《重慶醫(yī)科大學》2015年碩士論文

【摘要】：目的：評估超重或肥胖2型糖尿病患者以大劑量胰島素為基礎(chǔ)的方案轉(zhuǎn)為非胰島素方案治療的安全性和有效性。方法：2013年10月至2014年9月于重慶醫(yī)科大學附屬第二醫(yī)院就診、病程三年以上、超重或肥胖的2型糖尿病患者80例,平均年齡63歲,糖化血紅蛋白(HbAlc)7.0-10.0%,體重指數(shù)(BMI)25kg/m2,胰島素或胰島素類似物的用量40IU/日,隨機分為非胰島素治療和持續(xù)胰島素治療2組,觀察24周,比較2組的HbAlc、空腹血糖、餐后血糖、體重變化、BMI、HbAlc達標率、低血糖事件發(fā)生率等,所有數(shù)據(jù)采用EXCEL軟件收集整理,并應(yīng)用SPSS18.0軟件進行分析。結(jié)果：排除依從性差、未按時隨訪病例,69例2型糖尿病患者納入最終分析,兩組基線時各項指標沒有顯著性差異。隨訪12周后非胰島素組的腰圍、臀圍、BMI均小于胰島素組,有統(tǒng)計學意義(P0.05)；隨訪24周后,除了腰、臀圍及BMI外,兩組間體重的差異也有統(tǒng)計學意義(P0.05)。非胰島素組患者隨訪12周、24周后,與基線相比其體重、BMI、腰圍、臀圍、空腹血糖、甘油三酯均有所下降,其差異有統(tǒng)計學意義(P0.05),且在24周時患者的餐后血糖也低于基線,差異有統(tǒng)計學意義(P0.05)。最后,非胰島素組和胰島素組患者在入組時(24周時)的HbA1c達標率分別為29.03%(38.71%)、28.95%(34.21%)；兩組患者的低血糖事件發(fā)生概率也有明顯差異,非胰島素組不發(fā)生或僅有一次低血糖事件的概率分別為58.06%、25.81%,共約83.87%,而胰島素組在低血糖事件1X5或X≥5(X為低血糖事件發(fā)生次數(shù))的概率分別為23.68%、18.42%,共約42.10%。結(jié)論：通過本研究發(fā)現(xiàn),非胰島素組患者的體重、BMI、腰、臀圍以及甘油三酯呈明顯下降趨勢,而該組患者低血糖事件發(fā)生率也相對更低,這些指標均與心血管事件密切相關(guān),并向著有利的方向發(fā)展,故考慮超重或肥胖2型糖尿病患者有望將大劑量胰島素轉(zhuǎn)為非胰島素治療方案,且有可能對患者的心血管安全有著深遠的影響。
[Abstract]:Objective: to evaluate the safety and efficacy of high-dose insulin-based regimen to non-insulin regimen in overweight or obese type 2 diabetic patients. Methods: from October 2013 to September 2014, 80 patients with type 2 diabetes mellitus with the course of more than three years and overweight or obese were enrolled in the second affiliated Hospital of Chongqing Medical University, with an average age of 63 years. Hemoglobin glycosylated hemoglobin (HbAlc) 7.0-10.0, body mass index (BMI) = 25kg / m2, insulin or insulin analogue dosage (40 IUU / d) were randomly divided into two groups: non-insulin treatment group and continuous insulin treatment group. The two groups were observed for 24 weeks, and compared with two groups: HbAlc, fasting blood glucose, postprandial blood glucose. All the data were collected by excel software and analyzed by SPSS 18.0 software. Results: excluding poor compliance 69 patients with type 2 diabetes were included in the final analysis without timely follow-up. There was no significant difference between the two groups at baseline. After 12 weeks follow-up, the waist circumference and hip circumference BMI of the non-insulin group were all lower than that of the insulin group (P 0.05), and after 24 weeks follow-up, there were significant differences in body weight between the two groups in addition to waist, hip circumference and BMI. After 12 weeks and 24 weeks follow-up, the body weight, waist circumference, hip circumference, fasting blood glucose and triglyceride in the non-insulin group were all decreased, and the postprandial blood glucose was lower than the baseline at 24 weeks. The difference was statistically significant (P 0.05). Finally, the HbA1c standard rate of non-insulin group and insulin group was 29.03 / 38.71and 28.9595 / 34.21, respectively. There was also a significant difference in the probability of hypoglycemic events between the two groups. In the non-insulin group, the probability of no or only one hypoglycemia event was 58.06 or 25.81, which was about 83.87, while in the insulin group the probability of hypoglycemic event occurred at 1X5 or X 鈮，

本文編號：2019795