A Comparative Study Of Two Different Insulin Treatment Regimens In Patients With Type 2 Diabetes Who Have Poor Glycemic Control With Oral Hypoglycemic Drugs

Objective: To observe the proportion of 50/50 premixed insulin analogues(LM 50)and basal insulin analogues(Glycyrrhizin)in patients with type 2 diabetes with poor glycemic control after oral hypoglycemic therapy in China.The efficacy and safety of insulin therapy were compared,and the effects of the above two different treatment regimens on islet β-cell function in type 2 diabetic patients with poor glycemic control in China.Methods :From September 2016 to September 2017,the Department of Endocrinology and/or Hospitalization of the Hospital only used oral hypoglycemic agents(OADs)(≤3 different mec-hanisms of hypoglycemic agents)hypoglycemic≥3 After the month,patients with blood glucose still fail to meet the standard.In this study,patients with primary OADs(mainly sulfonylureas and biguanides)who had a la-boratory outcome of at least 3 months and who met HbA1c≥7.0% and agreed to receive a combined insulin regimen were randomized.The 50%-50 premixed insulin analogue(LM50)was injected twice daily(Group A=38)and combined with basal insulin(glargine)once daily(Group B n=39),the gender,age,duration,height,weight,body mass index(BMI),fasting triglyceride(TG),fasting blood glucose(FPG),and postprandial 2h blood glucose(2hPG)were recorded in the two groups.Baseline data such as fasting insulin(FINS)and glycosylated hemoglobin(HbA1C),TyG2 was calculated by TG and 2hPG,HOMA-β,HOMA-IR and DI index were obtained by FPG and FINS to evaluate the islet β-cell reserve capacity beforetreatment.Follow-up 24 weeks,educate and guide patients Perform daily fasting and postprandial 2h blood glucose self-monitoring and record the occurrence of hypoglycemia.After 24 weeks,the above data of different insulin treatment regimens were tested again.The change range of each data before and after,the fasting blood glucose compliance time,and the 2h postprandial blood glucose compliance time were compared.HbA1 c compliance rate,insulin dosage,number of hypoglycemia occurrences,body weight and BMI changes.Before and after self-control and comparison between groups,the differences in efficacy and safety of the above two different insulin treatment regimens were discussed,as well as the effects on improving islet β-cell function,especially after insulin sugar load.Observation data included FPG,2hPG,FIns,HbA1 c,TG,BMI,HOMA-IR,HOMA-β,DI,TyG2.EpiData software was used for data entry,SPSS18.0 statistical software for statistical analysis,normal distribution data were average ± variance((?)± s)table,paired t test for data comparison before and after treatment,comparison between groups with independent t Examination,when P < 0.05 was considered statistically significant.Results: 1.A total of 77 patients with type 2 diabetes who met the above conditions were selected,all of which were followed up.The age,sex,disease duration,height,weight,BMI,FPG,2hPG,HbAlc,before and after treatment.There were no significant differences in TG,FINS,HOMA-IR,HOMA-β,DI and TyG2 indexes(P>0.05).After 24 weeks of treatment,FPG,2hPG,HbA1 c,HOMA-IR,HOMA-β,DI and TyG2 in group A and group B were significantly lower than those before treatment,which was statistically significant(P<0.05).3.Comparison of body weight,BMI,FPG,2hPG,HbA1 c,TG,FIns,HOMA-IR,HOMA-β,DI,TyG2 before and after treatment in groups A and B.ΔFPG and Δ2hPG between group A and group B The difference was statistically significant(P<0.05),and there was no significant difference between the other groups(P>0.05).4.The blood glucose level of group A was shorter than that of group B.The blood glucose level after treatment was longer,the difference was statistically significant(P<0.05).There was no difference between the two groups(P>0.05).There was no significant difference in HbA1 c compliance rate between the two groups(P>0.05).5.the two groups of treatment for 24 weeks,the average insulin dosage in group B was less than that in group A,the difference was statistically significant(P<0.05).6.After 24 weeks of follow-up,there was a slight increase in body weight and BMI between the two groups.There was no significant difference between the two groups(P>0.05).There was no serious hypoglycemia event in both groups,and mild hypoglycemia occurred.There was no significant difference in the rate(P>0.05).Conclusions: Patients with type 2 diabetes with poor glycemic control of oral hypoglycemic agents can significantly improve blood glucose and a certain degree of islet β-cell function by using two different insulin treatment regimens.Among them,the 50/50 type of premixed insulin group has a better ability to regulate postprandial blood glucose than basal insulin,showing its unique advantages.Although the results of this study suggest that there is no difference in the ability of two different insulin regimens to improve insulin resistance and overall insulin secretion,it is not excluded from the smaller sample selection in this study,but the comparison of differential data still suggests a premixed insulin regimen.The function of improving insulin secretion before and after the sugar load may be better than that of the basal insulin group.There was no difference in HbA1 c compliance rates between the different treatment regimens,but the basal insulin averaged less insulin.Adverse events included an increase in body mass index and an incidence of hypoglycemia events without significant differences between the two groups.However,in view of the fact that the number of insulin injections,the amount of insulin,etc.,may lead to a reduction in patient satisfaction and compliance,this treatment is not recommended for patients with irregular life,poor self-management,and poor compliance.The 50/50 type of pre-mixed insulin analog eucalyptus 50 treatment program as the initial insulin treatment program,for the control of oral hypoglycemic agents in type 2 diabetes in China for ≥ 3 months,showing high postprandial blood glucose and high blood sugar fluctuation This type of characteristic population is more effective,although the number of early and late injections will reduce the patient’s acceptance,and the risk of weight gain and hypoglycemia is not significantly higher than that of basal insulin,and the control of postprandial blood glucose gradually stabilizes and then gradually decreases.It may be more appropriate to use insulin doses or basal insulin.In summary,the choice of initial insulin treatment regimen should take into account the patient’s heterogeneity and develop the most beneficial individualized rationalization treatment.