The Effects Evaluation Of Three Basal Insulin Combined With Oral Drugs On The Blood Glucose Fluctuation Using Continuous Glucose Monitoring System And Its Clinical Significance

Objective:Add insulin glargine injection, insulin detemir injection, neutral protamine hagedorn Injection(NPH) separately with oral drugs on the patients with type 2 diabetes mellitus(T2DM) less than 5 years.Compare the fluctuation of patients when their fasting blood glucose reaching the standard with the dynamic monitoring of blood glucose(CGMS).Then compare the hypoglycemic effect and safety of three groups.Divide patients of three groups into two sub-groups according to body mass index(BMI), and compare blood glucose fluctuation of 6 groups to provide the selection basis for the choice of initial basal insulin in clinical practice.Method:60 patients, T2 DM patients less than 5 years,aged 18~ 70,were randomly selected in the study,who hospitalized in Shanxi People’s Hospital from 2013 August to 2014 October.All patients were given metformin enteric coated tablets(500mg,3times/day) and Acarbose Tablet(50mg,3 times/day).T2 DM patients who have substandard blood glucose were given metformin enteric coated tablets orally the same dose(1000mg,2times/day).At the same time,add 3 basal insulin randomly(Insulin Glargine,Insulin Detemir,NPH).2weeks later,test patients blood glucose fluctuation for 3 days when their fasting blood glucose dropped less than 7.0mmol/l.Compare the CGMS parameters, insulin dosage, theincidence rate of hypoglycemia etc.Divide patients of three groups into two sub-groups according to body mass index(BMI), and compare blood glucose fluctuation of 6 groups Results:1.(1)Patients of glargine group and detemir group had lower blood glucose level on24 hours blood glucose(24h MBG) 、mean amplitude of glycemic excursion(MAGE),before and after meals and bedtime blood glucose than those of NPH group;(2)Insulin dose of patients in glargine group and detemir group is higher than that of NPH group;(3)Patients’ blood glucose level at 3 am,TPG≥10mmol/l(%)、TPG≤3.9mmol/l(%) among glargine group,detemir group, NPH group had no significant difference.(4) Patients in NPH group had hypoglycemia clinical manifestation like palpitation, sweating ect..2.The experimental results of different groups according to BMI :(1) between the two groups:there was no significant difference between glargine group, detemir group and NPH group on 24 h MBG; patients’ MAGE, TPG ≧10mmol/l(%), TPG ≦3.9mmol/l(%) in glargine group, detemir group were not statistically significant and both lower than those in group NPH;there was no significant difference in 3 am blood glucose levels between patients in glargine group and detemir group, which were both higher than those in NPH group; For the dosage of insulin, there was no significant difference between patients with BMI < 24(kg/m2) in glargine group and detemir group,which were both higher than NPH group.BMI = 24(kg/m2) in patients with glargine group is higher than that of NPH dosage group, two patients were higher than those in NPH group.(2) Within group comparison: patients with BMI < 24(kg/m2) are the same in 24 h MBG with patients with BMI≧24(kg/m2);patients with BMI < 24(kg/m2) were lower in dosage of insulin,3am blood glucose and TPG≧10mmol/l(%) than patients with BMI≧24(kg/m2);atients with BMI < 24(kg/m2) are the same in 24 h MBG with patients with BMI≧24(kg/m2);patients with BMI < 24(kg/m2) were higher in MAGE,TPG≦3.9mmol/l(%)than patients with BMI≧24(kg/m2).Conclusion:Insulin glargine, insulin detemir, neutral protamine hagedorn(NPH) all can reach the hypoglycemic purpose for those middle-aged patients who has the same BMI and need initial insulin therapy.There is no significant difference of blood glucose fluctuation parameter and insulin dosage between glargine group and detemir group.The effect of NPH on the blood glucose fluctuation is higher than the other two groups, which indicates the risk of hypoglycemia and hyperglycemia is increasing. While the insulin dosage in NPH group is less than other two group;for patients with different BMI,when BMI <24(kg/m2), the dosage of insulin glarginewas less than insulin detemir,when BMI ≥24(kg/m2), the dosage of insulin detemir was less than insulin glargine, but there was no significant difference in blood glucose standard and fluctuation with insulin glargine group.So, the treatment options, BMI < 24(kg/m2) in patients with insulin glargine more economical choice, better glucose control, BMI ≥ 24(kg/m2) in patients with insulin detemir is more economical choice, better glucose control.