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中国临床药理学与治疗学 ›› 2024, Vol. 29 ›› Issue (2): 171-176.doi: 10.12092/j.issn.1009-2501.2024.02.007

• 药物治疗学 • 上一篇    下一篇

胰岛素泵短期强化治疗2型糖尿病的疗效及影响因素分析

沈纪中,唐继发   

  1. 南京大学医学院附属鼓楼医院药学部,南京  210008,江苏
  • 收稿日期:2023-08-09 修回日期:2023-12-21 出版日期:2024-02-26 发布日期:2024-02-02
  • 作者简介:沈纪中,男,博士,副主任药师,硕导,研究方向:临床药理学。 E-mail: sjzxlf@163.com
  • 基金资助:
    江苏省研究型医院学会专项科研基金项目(JY202012);吴阶平医学基金会临床科研专项资助基金项目(320.6750.19090-29);国家自然科学基金项目(81302817);江苏省六大人才高峰计划项目(WSN-004)

Effects of short-term intensive insulin pump treatment on type 2 diabetes and its influencing factors

SHEN Jizhong, TANG Jifa   

  1. Department of Pharmacy, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing 210008, Jiangsu, China
  • Received:2023-08-09 Revised:2023-12-21 Online:2024-02-26 Published:2024-02-02

摘要:

目的:观察胰岛素泵持续皮下胰岛素输注(continuous subcataneous insulin infusion,CSII) 短期强化治疗2型糖尿病(T2DM)患者的真实世界疗效并探讨疗效关联的影响因素。方法:对本院收治住院治疗的369例T2DM患者开展CSII短期强化治疗,依据治疗第5天的血糖水平,分组为血糖控制达标组和血糖控制不达标组。比较两组患者的糖代谢、生理、生化等方面指标的差异,采用回归统计方法,分析胰岛素泵疗效的影响因素。结果:经过4 d CSII短期治疗,225例(61%)患者血糖控制达标,144例(39%)血糖控制未达标。与达标组相比,未达标组年龄更大,每千克体重每日胰岛素总剂量(TDD)、空腹血糖(FBG)、空腹胰岛素、空腹C肽、胰岛素抵抗指数(HOMA-IR)水平更高,而血磷、胰岛素生长因子1(IGF1)水平则是显著低于达标组。生化指标方面,两组在血脂水平、肝功能、肾功能整体上无显著差异。单因素回归及多因素逐步回归分析结果表明,餐后2 h胰岛素、TDD、血磷是胰岛素泵疗效的关键影响因素。其中,血糖控制达标与血磷呈正相关,与餐后2 h胰岛素、TDD呈负相关。结论:使用胰岛素泵持续皮下输注胰岛素是短期强化治疗T2DM的理想方法,为了获得更满意的血糖控制达标率,临床使用时应更加关注患者的血磷、餐后2 h胰岛素指标水平及TDD。

关键词: 胰岛素泵, 2型糖尿病, 真实世界, 临床疗效

Abstract:

AIM: To observe the real world efficacy of continuous subcutaneous insulin infusion (CSII) with insulin pump in short-term intensive treatment of patients with type 2 diabetes (T2DM) and explore the influencing factors associated with efficacy. METHODS: A total of 369 hospitalized T2DM patients were treated with CSII short-term intensive therapy. Based on the blood glucose levels on the 5th day of treatment, they were divided into two groups, namely the qualified blood glucose control group and the non-qualified blood glucose control group. The differences of glucose metabolism, physiology, biochemistry and other indicators between the two groups were compared, and the influencing factors of insulin pump efficacy were analyzed by regression statistics. RESULTS: After 4 days of CSII short-term treatment, 225 patients (61%) achieved blood glucose control standards, while 144 patients (39%) did not achieve blood glucose control standards. Compared with the qualified blood glucose control group, the non-qualified blood glucose control group was older and with higher levels of total daily insulin dose per kilogram of body weight (TDD), fasting blood glucose (FBG), fasting insulin, fasting C-peptide, and insulin resistance index (HOMA-IR), while lower levels of blood phosphorus, insulin growth factor 1 (IGF1). In terms of biochemical indicators, there was no significant difference between the two groups as a whole, including blood lipid levels, liver function, and kidney function. The results of univariate regression and multivariate stepwise regression analysis showed that 2-hour postprandial insulin, TDD and blood phosphorus were the key factors influencing the efficacy of Insulin pump. Among them, qualified blood glucose control was positively correlated with blood phosphorus, and negatively correlated with 2-hour postprandial insulin and TDD. CONCLUSION: CSII with insulin pump is an ideal method for short-term intensive treatment of type 2 diabetes. In order to achieve a more satisfactory rate of qualified blood glucose control, more attention should be paid to the patient's blood phosphorus, 2-hour postprandial insulin and TDD in clinical use. 

Key words: insulin pump, type 2 diabetes, real world, clinical efficacy

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