Comparison The Effectiveness Of Three Types Insulin(Glargine、NPH And Detemir) In The Intensive Insulin Therapy Of Type2Diabetes Patients

Objective:Prevalence of type2diabetes (T2DM) is growing rapidly, there is no cure. Implementation of intensive insulin therapy for T2DM could control blood glucose quickly while preventing and delaying the development of diabetic complications. Glargine, Neutral Protamine Hagedorn (Novolin N, NPH) and detemir had their own characteristics, could be used as the basal insulin. it was observed effectiveness of Glargine, NPH or detemir in intensive insulin treatment for inpatients with T2DM.Materies and methods:172inpatients with T2DM (aged40to70years, HbAlc>7%, type2diabetes diagnosed according to1999WHO diagnostic criteria) were included in the study, which hospitalized in the department of endocrinology for10～14days. The objects were randomized to be divided into three groups: group I (domestic glargine group, n=57), group Ⅱ (NPH group, n=55) and groupⅢ (detemir group, n=60). The objects were selected to disable the original treatment plan to control blood glucose, and switched to intensive insulin therapy with3times of Novolin R and one time of basal insulin daily, basal insulin were selected randomly from domestic glargine、NPH or detemir. Meanwhile all the objects kept the strict diabetes diet and exercise. The dose of insulin in groups was adjusted according to the blood glucose concentration, without any hypoglycemic oral drugs. The targets of the blood glucose concentration were fasting plasma glucose<7mmol/L, postprandial2-hour blood glucose concentration<10mmol/L. According to the provisions of clinical pathways, the course of intensive insulin therapy time were10to14days, the objects were out of the study when total insulin dose>70U/d during therapy. The change of fasting plasma glucose、fasting insulin、fasting c-peptide、postprandial2-hour plasma glucose、postprandial2-hour plasma insulin、postprandial2-hour plasma c-peptide、HbA1c、HOMA-IR in before and after treatment were recorded and their changes were compared in groups. And hypoglycemia occur、daily insulin dose、therapeutic time and insulin cost in3groups were compared.Results:At the end of the study,172cases were excluded from14cases,9cases excepted and48cases remained in group Ⅰ, five cases excepted and50cases remained in group Ⅱ, without excluding in groupⅢ, because the total daily insulin than70U. The data of baseline in three groups showed no significant difference. Three groups of treatment could significantly reduce fasting (1.61±4.05mmol/L,1.96±2.89mmol/L,1.65±3.22mmol/L,all P<0.01) and postprandial glucose (11.22±10.18mmol/L,10.91±5.11mmol/L,9.26±9.08mmol/L, all P<0.01), HbA1c levels (0.61±0.72%,0.63±0.55%,0.61±0.57%, all P<0.01). Fasting and postprandial insulin concentrations of each group were elevated up significantly higher (P<0.01). Fasting C-peptide concentration in group Ⅰ and Ⅲ were significantly higher (P<0.01), but in group Ⅱ was elevated and not statistically significant. Postprandial C-peptide concentration in each group decreased, no statistically significant. HOMA-IR of groups Ⅰ andⅢwere rose, HOMA-IR of group Ⅱ was fell, the changes were not statistical significance. There was no significant difference control of blood glucose time required and daily doses of short-acting insulin of per kilogram of body weight between the groups, but daily doses long-acting insulin of per kilogram of body weight in group Ⅰ were significantly higher than that in group Ⅱ (0.25±0.07vs0.19±0.07) and in groupⅢ (0.25±0.07vs0.19±0.06)(all P<0.05), as same as, daily doses of total insulin of per kilogram of body weight in group I were significantly greater than that in group Ⅱ and group Ⅲ (P<0.05and P<0.01). Due detemir highest price, so the daily medication cost showed that the cost in groupⅢwas higher than in group Ⅰ, in group Ⅱ was the lowest, there were significant differences between groups (all P<0.01). Within a specified time after the treatment, the proportion of blood glucose uncontrol in the achievement in group Ⅰ was the highest, in groupⅢwas the lowest, differences between the groups were statistically significant (all P<0.05). The ratio of cases of the use of insulin-day total dose of more than70U in group Ⅰ was higher than that in group Ⅱ, in group Ⅱ than in groupⅢ, there was significant difference between groups (all P<0.05). Incidence of hypoglycemia of group Ⅰ was the lowest, there were no significant differences between the groups. Conclusions:T2DM patients hospitalized for short-term intensive insulin therapy, intensive treatment program of basal insulin glargine, NPH and detemir could effectively control fasting and postprandial glucose concentration in inpatients with T2DM, significantly reduce HbAlc values. The protection of islet β cells function glargine and detemir compared with NPH significantly. The time of needed to control blood glucose standard basal and the incidence of hypoglycemia between the basal insulins was no significant difference. Domestic glargine at insulin sensitivity and biological reactivity worse than NPH and detemir.