Investigation Of Targeted Dosage Of Biphasic Insulin Aspart30in≥80Years Old Patients With Newly Diagnosed Type2Diabetes Mellitus

Objective:To provide better guide for the treatment by investigation of targeted dosage of biphasic insulin aspart30in≥80years old patients with newly diagnosed type2diabetes mellitus.Methods:Totally80elderly patients with newly diagnosed type2diabetes mellitus were enrolled and divided into three groups:group A(60-69yrs), group B (70-79yrs), group C (≥80yrs). Their data were collected, including personal history, complications, body mass index and laboratory examinations such as fasting blood glucose(FPG),2h postprandial plasma glucose (2hPG)、 fasting insulin and fasting C-peptide(C-P), hemoglobin Alc(HbAlc)、 total cholesterol and triglyceride. All patients of these three groups received biphasic insulin aspart30treatment for12weeks and their dosages were adjusted according to blood glucose level. The time to get well-balanced blood glucose, insulin dosages, and the occurrence of hypoglycemia were recorded. The related factors affecting the targeted dosage were analyzed by multiple linear stepwise regression model.Results:1. There was no significant difference in body mass index, total cholesterol and triglyceride between three groups (P<0.05). Levels of HOMA-P of patients in group C and B were significantly lower than that in group A (P<0.05). Levels of HOMA-IR of patients in group A and B group were significantly higher than that in group C (P<0.05).2. Levels of FBG,2hPG, HbAlc, complications in group C were significantly higher than that in other two groups (P<0.05).3. After12weeks treatment, levels of FBG,2hPG, HbAlc were decreased (P<0.05) in three groups. But FBG,2hPG, HbAlc in C group (≥80years) were higher than the other two groups, and control is poor(P<0.05); the time to get well-balanced blood glucose of patients in group C were significantly lower than that in other two groups (P<0.05).4. The insulin dose in group C was significantly higher than A group and B group [40.37±8.53u.d-1vs22.55±4.90u.d-1vs35.24±6.54u.d-1, P<0.05], but the targeted insulin dosage per kilogram body weight was not different from group B[0.62±0.12u.kg-1.d-1vs0.72±0.13u.kg-1.d-1,P>0.05]. The days needed for achieving good control of blood glucose were longer than that in other two groups [(16.11±1.46) d vs (8.09±0.20) d vs (10.62±0.80) d, P<0.05], the incidence of hypoglycemia was significantly higher in group A and group B[30%vs7%vs16%,P<0.05].5. The insulin dose proportion before breakfast was lower than that of the initial dose in three groups, and the insulin dose proportion before the evening meal were higher than the initial dose in three groups (P<0.05),and the the changes of insulin dose proportion in C group was obvious [before breakfast (54.70±2.84)%vs67%, before the evening meal (45.29±2.84)%vs33%, P<0.05]6. The insulin dosage for patients in group C was positively related to FBG (r=0.428, P=0.042), HbAl c (r=0.415, P=0.049), the occurrence of hypoglycemia (r=0.574,P=0.007) and complications (r=0.568, P=0.007), while negatively correlated with HOMA-β(r=0.674, P=0.002).7. The result of multiple stepwise regression analysis indicated that the main influence factors in≥80years old patients with newly diagnosed type2diabetes mellitus were HbAlc and the occurrence of hypoglycemia.Conclusions:1. The≥80years old patients with newly diagnosed type2diabetes mellitus had the highest blood glucose levels and targeted insulin dosage, most complications and the occurrence of hypoglycemia. And their blood glucose levels were not easy to get controlled. Their islet β cell function declined. Targeted insulin dosage was40.37±8.53u.d-1, the targeted insulin dosage per kilogram body weight was0.62±0.12u.kg-1.d-1, The insulin dose before breakfast occupied (54.70±2.84)%of daily total insulin dosage and the insulin dose before the evening meal occupied (45.29±2.84)%.2. The insulin dosage for patients in group C was positively related to FBG, HbAlc, the occurrence of hypoglycemia and complications, while negatively correlated with HOMA-β.3. Their targeted insulin dosage was mainly associated with HbAlc and the occurrence of hypoglycemia.