2型糖尿病住院患者不同胰岛素强化方式的效果及出院时降糖方案选择的临床观察

Clinical Observation on the Effect of Different Insulin Intensification Modalities and the Choice of Glucose-Lowering Regimen at Discharge in Hospitalized Patients with Type 2 Diabetes Mellitus

摘要: 目的：通过回顾性研究分析2型糖尿病患者不同的胰岛素强化方式的治疗效果及出院时降糖方案的选择。方法：选择黄石市中医医院2021年3月~2023年3月收治的201例2型糖尿病血糖控制不佳的患者为研究对象，按照胰岛素强化方式的不同，分为皮下注射胰岛素组(85例，即A组)及胰岛素泵组(116例，即B组)。比较两组患者治疗后的空腹血糖、餐后2 h血糖、胰岛素及C肽、胰岛素分泌指数、血糖达标时间、用药依从性、疗效及出院带药方案的不同。结果：治疗后，所有患者FPG、2hPG均低于治疗前，差异有统计学意义(P < 0.001)。治疗后，两组患者FPG、2hPG比较，差异无统计学意义(P > 0.05)；相对于A组而言，B组患者的血糖达标时间更短，低血糖发生率更低，出院后用药依从性更高，差异具有统计学意义(P < 0.05)；B组与A组患者出院时无药缓解的比例分别为2.59%、0，差异无统计学意义(P > 0.05)；B组与A组患者出院时选择口服降糖药的比例分别为57.76%、40%，差异有统计学意义(P < 0.001)；B组与A组患者出院时选择胰岛素的比例分别为39.66%、60%，差异有统计学意义(P < 0.001)。结论：2型糖尿病患者选择胰岛素泵强化治疗相比于多次皮下注射胰岛素治疗而言能够更好地控制血糖水平，恢复胰岛β细胞功能，更快地达到高血糖缓解，出院后继续使用胰岛素的概率更低、治疗方案更简便、患者用药依从性更高。

Abstract: Objective: To analyze the therapeutic effects of different insulin intensive methods in patients with type 2 diabetes and the choice of hypoglycemic regimen at discharge. Methods: A total of 201 pa-tients with poor blood sugar control of type 2 diabetes admitted to Huangshi Hospital of Traditional Chinese Medicine from March 2021 to March 2023 were selected as the research objects. They were divided into subcutaneous insulin injection group (85 cases, Group A) and insulin pump group (116 cases, Group B) based on the different methods of insulin strengthening. The study compared the differences in fasting blood glucose, postprandial 2 h blood glucose, insulin and C-peptide, insulin secretion index, time to reach blood glucose standard, medication compliance, curative effect and discharge medication regimen between the two groups after treatment. Results: After treatment, FPG and 2hPG of all patients were lower than those before treatment, and the difference was statis-tically significant (P < 0.001). After treatment, there was no statistically significant difference in FPG and 2hPG between the two groups (P > 0.05). However, the time for blood glucose to reach the standard was shorter in Group B, the incidence of hypoglycemia was lower, and the medication compliance after discharge was significantly lower, and the differences were statistically significant (P < 0.05). The rate of drug-free remission was 2.59% and 0 in Group B and Group A respectively, and the difference was not statistically significant (P > 0.05). Additionally, 57.76% and 40% of the patients in Group B and Group A respectively chose oral hypoglycemic agents when they were dis-charged from the hospital, and the difference was statistically significant (P < 0.001); the propor-tions of patients in Group B and Group A who chose insulin at discharge were 39.66% and 60%, re-spectively, and the differences were statistically significant (P < 0.001). Conclusion: Patients with type 2 diabetes choose insulin pump intensive therapy compared with multiple subcutaneous insu-lin injections to better control blood glucose levels, restore islet β-cell function, achieve hypergly-cemic remission more quickly, and have a lower probability of continuing insulin use after dis-charge, a simpler treatment plan, and higher patient compliance with medication.