Analysis Of The Status Of Basal Insulin Therapy In Patients With Type 2 Diabetes Who Are Poorly Controlled By Oral Antidiabetic Drugs

Background:Since twentieth Century,the incidence of type 2 diabetes has increased year by year.Type 2 diabetes mellitus and its complications bring heavy burden to patients and their families,and seriously affect the quality of life of patients.The application of oral antidiabetic drug(OAD)poorly controlled patients with type 2diabetes,diabetes guidelines at home and abroad are recommended to use insulin supplementation or replacement therapy to control blood sugar strictly,to prevent or reduce the occurrence and development of complications.However,the side effects of insulin such as obesity,pain,hypoglycemia,insulin resistance and so on,which cannot participate in the part of doctors and patients.Basal insulin has the advantages of easy to use,low risk of hypoglycemia,long duration and high compliance.There is a variety of basic insulin,but in clinical diagnosis and treatment of patients with type2 diabetes patients with different types of basal insulin use efficacy,safety has not yet a clear conclusion.Objective:To investigate whether the use of insulin glargine and NPH in patients with type2 diabetes in patients who are not effective in the use of oral hypoglycemic drugs in our hospital or in the hospital.Methods:According to the inclusion and exclusion criteria,select the outpatient department of the Second Affiliated Hospital of Nanchang University from December2011 to June 2013 and the inpatient department in patients with type 2 diabetes in 99 cases,the object of the study is the use of oral hypoglycemic drugs poorly controlled,and began to accept the basis of insulin(BI)treatment in patients with type 2 diabetes.Patients who received insulin therapy were randomly assigned to either the insulin glargine group or the NPH treatment group.Each patient received investigation after admission into the group,the third months and the sixth months.By a questionnaire,Patients were asked a series of questions in 3 times visits,about diabetic diet and exercise,the type and dose of the oral antidiabetic drug used now,the use of insulin in the past,self-monitoring of blood glucose(SMBG),fasting blood glucose after treatment,whether the occurrence of severe hypoglycemia,severely low blood sugar,untoward reaction Quality of life before and after insulin administration.During half-yearly use of basic insulin,except for the doctor appropriately adjust the patient's insulin dose according to the patient's blood glucose,no intervention in patients with diet,exercise and treatment.The observation indexes include: insulin glargine treatment group and NPH treatment group in age,gender,height,weight,duration of diabetes,blood pressure and so on.There is no smoking history,there are no complications.Before and after treatment Hb A1 c,Fasting serum glucose level,Hb A1 c compliance rate after treatment,body weight change before and after treatment,changes in quality of life before and after treatment,as well as changes in the patient's self status,The number of occurrence of different types of hypoglycemia.Results:1.In 99 patients,96 patients completed 6 months of follow-up.44 patients treated with insulin glargine group baseline Hb A1 c levels between 7.4-12.6%,the average value is 9.06 + 1.78% baseline fasting blood glucose in 6.1 ~ 12.3mmol/l,the average value was 9.41 + 1.61mmol/L.baseline insulin dose is between 6-14 U,the average value of 9.27 + 2.35 U,0.14 + 0.03U/Kg/d.52 patients received NPH treatment group and baseline Hb A1 c levels between 7.0-12.8%,the average value was 8.558 + 1.56%;baseline fasting blood glucose in 7 ~ 17.5mmol/l,the average value was 10.10 + 3.16mmol/L.baseline insulin dose is between 6-14 U,the average value of 9.92 + 2.68 U,0.16 + 0.05U/Kg/d.2.Two groups of basic insulin,glycosylated hemoglobin and fasting serum were significantly decreased(P<0.01),at the end of treatment were increased by insulin dose.Hb A1 C < 7% compliance rate,44 cases of insulin glargine treatment after glycated hemoglobin 18,compliance rate of 40.9%;52 cases of NPH treatment group glycated hemoglobin 22.The standard rate of 42.3% between the two groups there was no significant difference between the standard.3.The two groups before and after insulin therapy of body weight,body mass index,systolic blood pressure,diastolic blood pressure,EQ-5D index,the rate of hypoglycemia had no changes,EQ-VAS score higher than that before treatment.Two groups of basal insulin treatment before five dimensions are most frequently reported pain / discomfort in 16 cases after treatment.The report is the most pain /discomfort in 10 cases.4.After treatment,44 cases of the insulin glargine group,there were 4 cases of low blood sugar,52 cases of NPH group,there were 6 cases of hypoglycemia,all of the patients with low blood glucose during the day.There was no significant difference between the two groups(P>0.05).5.There was no significant difference in the efficacy of insulin glargine and NPH treatment in different course of disease(P>0.05).Conclusions:1.This study shows that patients with type 2 diabetes with poor glycemic control can significantly reduce fasting blood glucose and Hb A1 c.In the different course of the disease,There is no difference between glycemic insulin and the NPH.2.In the real world,for patients with type 2 diabetes who were not well controlled by oral antidiabetic agents,the initial basal insulin therapy was late,and the initial basal insulin dose was significantly lower,later than the guidelines recommend and initial basal insulin dose is obviously inadequate,adjusting the dose is not sufficient.3.The incidence of hypoglycemia was low in the initial basal insulin therapy,which did not affect the body weight and blood pressure,and the safety was good.4.The quality of life of patients with type 2 diabetes mellitus was significantly improved after initial insulin therapy.