Study on the influencing factors of basal insulin combined with oral medication in the treatment of type 2 diabetes with poor glycemic control

doi:10.11958/20220091

Abstract

Abstract:

Objective To investigate the influencing factors of basal insulin combined with oral medication in type 2 diabetic patients with poor glycemic control. Methods A total of 208 patients with type 2 diabetes mellitus with poor blood glucose control were selected from the Department of Endocrinology of Handan Central Hospital. Patients were treated with multiple daily injections of insulin (MDI) after admission. After achieving and maintaining the blood glucose control target for 1 week, the islet function was evaluated and the therapy was shifted to basal insulin-supported OAD (S) therapy (BOT). Patients were classified as the achieving group, if fasting plasma glucose (FPG) and 2 h postprandial plasma glucose (2 hPG) reached the control target after 2 week. Others would be classified as the underachieving group. Patients in the achieving group who maintained their target at least 3 months were deemed to be responded to the BOT. Patients who failed to achieve the target were transferred to the underachieving group and received the MDI program. The baseline data of the two groups were compared, including duration of diabetes, body mass index (BMI), FC-P and 2 hC-P. The dosage of basal insulin and preprandial insulin during intensive insulin therapy were compared between the two groups. The influencing factors of BOT program in type 2 diabetes patients with poor blood glucose control were analyzed. Results Compared with the underachieving group, the achieving group had shorter duration of diabetes [6.50 (1.00, 10.00) years vs. 10.00 (3.25, 15.00) years，P<0.01], and higher BMI, FC-P, 2 hC-P and basal insulin dosage before conversion (P<0.05). Multivariate Logistic regression analysis showed that BOT program might not be successful in patients with long course of diabetes (OR=0.930, 95%CI: 0.876-0.987, P=0.017), while high levels of BMI (OR=1.145, 1.003-1.308, P=0.045), 2 hC-P (OR=2.866, 1.938-4.239, P<0.01) and basal insulin dosage (OR=1.254, 1.119-1.406, P<0.01) could promote the success of BOT program. Conclusion The duration of diabetes, BMI, 2 hC-P and the dosage of basal insulin are main factors influencing the conversion of type 2 diabetic patients with poor glycemic control to basal insulin combined with oral medication after intensive insulin therapy.

Key words: diabetes mellitus, type 2, C-peptide, insulin, body mass index, basal insulin, oral hypoglycemic drugs

CLC Number:

R587.1

Figures/Tables 2

References 12

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组别	n			年龄（岁）		性别（男/女）			病程（a）			BMI（kg/m²）			TG（mmol/L）			TC（mmol/L）		LDL-C（mmol/L）
未成功组	68			54.60±12.59		40/28			10.00（3.25，15.00）			22.60±4.12			1.54±1.30			4.74±1.43		2.79±0.89
成功组	140			53.27±12.70		83/57			6.50（1.00，10.00）			26.55±3.67			2.05±1.51			4.67±1.09		2.76±0.78
t、χ²或Z				0.711		0.004			2.890^＊＊			6.979^＊＊			2.401^＊			0.353		0.253
组别		HDL-C（mmol/L）			FPG（mmol/L）						HbA1c（%）			FC-P（μg/L）			2 hC-P（μg/L）				2 hC-P/FC-P
组别		HDL-C（mmol/L）			基线				MDI治疗后		HbA1c（%）			FC-P（μg/L）			2 hC-P（μg/L）				2 hC-P/FC-P
未成功组		1.23（1.02，1.42）			14.48±6.44				6.98±2.85		10.46±2.03			0.90（0.46，1.30）			1.40（1.00，2.06）				1.66（1.30，2.50）
成功组		0.98（0.82，1.13）			12.50±3.74				6.59±1.39		10.12±1.84			1.57（1.12，2.20）			3.67（2.63，5.19）				2.31（1.73，3.16）
t、χ²或Z		5.729^＊＊			2.333^＊				1.051		1.199			6.182^＊＊			8.511^＊＊				4.243^＊＊
组别			ΔC-P（μg/L）				用药（是/否）									胰岛素量（U）
组别			ΔC-P（μg/L）				INS	二甲双胍		AGI			Sus/glinides			餐时			基础			总量
未成功组			0.60（0.20，1.14）				34/34	31/37		8/60			28/40			19.91±3.99			15.81±4.29			36.68±8.14
成功组			2.00（1.23，3.06）				40/100	96/44		32/108			54/86			18.64±3.50			18.77±4.16			37.36±6.88
t、χ²或Z			8.315^＊＊				9.170^＊＊	10.168^＊＊		3.626			0.130			2.368^＊			4.767^＊＊			1.555

组别	n			年龄（岁）		性别（男/女）			病程（a）			BMI（kg/m²）			TG（mmol/L）			TC（mmol/L）		LDL-C（mmol/L）
未成功组	68			54.60±12.59		40/28			10.00（3.25，15.00）			22.60±4.12			1.54±1.30			4.74±1.43		2.79±0.89
成功组	140			53.27±12.70		83/57			6.50（1.00，10.00）			26.55±3.67			2.05±1.51			4.67±1.09		2.76±0.78
t、χ²或Z				0.711		0.004			2.890^＊＊			6.979^＊＊			2.401^＊			0.353		0.253
组别		HDL-C（mmol/L）			FPG（mmol/L）						HbA1c（%）			FC-P（μg/L）			2 hC-P（μg/L）				2 hC-P/FC-P
组别		HDL-C（mmol/L）			基线				MDI治疗后		HbA1c（%）			FC-P（μg/L）			2 hC-P（μg/L）				2 hC-P/FC-P
未成功组		1.23（1.02，1.42）			14.48±6.44				6.98±2.85		10.46±2.03			0.90（0.46，1.30）			1.40（1.00，2.06）				1.66（1.30，2.50）
成功组		0.98（0.82，1.13）			12.50±3.74				6.59±1.39		10.12±1.84			1.57（1.12，2.20）			3.67（2.63，5.19）				2.31（1.73，3.16）
t、χ²或Z		5.729^＊＊			2.333^＊				1.051		1.199			6.182^＊＊			8.511^＊＊				4.243^＊＊
组别			ΔC-P（μg/L）				用药（是/否）									胰岛素量（U）
组别			ΔC-P（μg/L）				INS	二甲双胍		AGI			Sus/glinides			餐时			基础			总量
未成功组			0.60（0.20，1.14）				34/34	31/37		8/60			28/40			19.91±3.99			15.81±4.29			36.68±8.14
成功组			2.00（1.23，3.06）				40/100	96/44		32/108			54/86			18.64±3.50			18.77±4.16			37.36±6.88
t、χ²或Z			8.315^＊＊				9.170^＊＊	10.168^＊＊		3.626			0.130			2.368^＊			4.767^＊＊			1.555

变量	β	SE	Wald χ²	P	OR（95%CI）
病程	-0.073	0.031	5.703	0.017	0.930（0.876~0.987）
2 hC-P	1.053	0.200	27.798	<0.001	2.866（1.938~4.239）
BMI	0.136	0.068	4.018	0.045	1.145（1.003~1.308）
基础胰岛素量	0.227	0.058	15.216	<0.001	1.254（1.119~1.406）
二甲双胍	0.985	0.439	5.042	0.025	2.678（1.133~6.327）
常数项	-9.360	1.897	24.340	<0.001	0.000

变量	β	SE	Wald χ²	P	OR（95%CI）
病程	-0.073	0.031	5.703	0.017	0.930（0.876~0.987）
2 hC-P	1.053	0.200	27.798	<0.001	2.866（1.938~4.239）
BMI	0.136	0.068	4.018	0.045	1.145（1.003~1.308）
基础胰岛素量	0.227	0.058	15.216	<0.001	1.254（1.119~1.406）
二甲双胍	0.985	0.439	5.042	0.025	2.678（1.133~6.327）
常数项	-9.360	1.897	24.340	<0.001	0.000

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