Hospitalized Patients With Type2Diabetes Two Kinds Of Comparative Levemir Treatment

Objective: by observing the two Levemir treatment (Levemir+NovoRapid andLevemir+Oral antidiabetic agents) in patients with type2diabetes mellitus in hospitalafter the glucose control level, the time needed for standard, standard daily expenses,incidence of hypoglycemia, and failure rate, Follow-up after discharge adhere to treatmenttime (month)，comparing two treatments of efficacy, safety，compliance and economiccosts.Methods: in May2013to January2014hospital endocrinology of22patients withtype2diabetes mellitus in hospital. Inclusion criteria for patients with:①In1999theWHO criteria for the diagnosis of type2diabetes mellitus (T2DM)；②Fasting bloodglucose (FBG)>10.0tendency/L;Postprandial2hours blood glucose (2HPBG)>15tendency/L;Hemoglobin A1c (A1c)>9%.；③Ages18to80years. Exclusion criteria for:1)have serious heart, liver and renal insufficiency;(2) have acute cardiocerebrovascularevents;(3) have infectious diseases;(4) have acute tdiabetes complications. To meet thecriteria for the cases were randomly divided into group A (Levemir+NovoRapid) andgroup B (Levemir+Oral antidiabetic agents). A group of10cases, B group of12cases（There are1case occurrence of acute cardiovascular events To eliminate；The remaining11cases with1case failed and not included in the queue，Finally comparing the number ofcases for10cases）. Ask for details of patients after admission history;According to theweight, height, calculate BMI;Understand the course of the disease, recording time(in);Phlebotomize FBG,2HPBG, HBA1C, fasting and postprandial2hour c peptide, GAD,IAA and ICA,24hours urinary biochemical, UAER, etc;Special examination (X-ray,electrocardiogram, heart colour to exceed, fundus examination, etc.);Patients afteradmission by endocrine routine nursing care, to diabetes diet, in diabetes education, dailyactivity as usual.Blood glucose regulation: group A: noble peace starting dose of0.2units per kilogram of body weight (u/kg), subcutaneous injection before sleep;Aspart starting dose of0.2u/kg, average10minutes before meals and subcutaneous injection.Blood glucosespectrum by5times a day, respectively: at3am in the morning, before breakfast,2hoursafter meals.Adjustment of insulin dosage, until blood glucose control is at target.Calculatestarting treatment until blood glucose control is at the required days and standard oralglucose-lowering drugs when the average daily expenses (group B as like).Record fallsbelow cases, calculate failure rate (falls below the number of cases/*100%) the totalnumber of the group.Group B: peace starting usage and dosage with group A;Oralmedications including double guanidine kind (metformin), promoting the secretion ofinsulin agent [sulphonylurea and column nai (gliclazide, Glenn urea, raigor column nai)],a glycosidase inhibitors (acarbose), insulin sensitization agent (pioglitazone), DPP-IVinhibitors (west Glenn), specific drugs vary from person to person.As group A, throughthe spectrum of blood sugar and insulin five times A day for oral administration dosage,until blood glucose control is at target.As A combination of the above oral medications tomaximum dosage for blood sugar is still not done or intolerance for oral administration togroup A scheme (not classified as group A), calculate failure rate.Blood sugar controltarget reference diabetes mellitus of Chinese medical association,2010edition of"Chinese type2diabetes prevention guide: tendency of3.9~7.2L fasting glucose, bloodsugar2hours after meals <10mmol/L.For various reasons, such as the dawnphenomenon, fluctuations in blood sugar, etc.) to meet the control target, can relaxappropriately, but must ensure that the blood glucose spectrum5times in three points ormore standard (at least one hollow point), the remaining points must be close to thestandard.manifestations of patients with hypoglycemia severity classification: mild: autonomicnervous symptoms, patients can handle;Moderate: autonomic nervous symptoms andneurological symptoms of low blood sugar, patients can be dealt to the line;Severe: bloodsugar concentration <2.8mmol/L (<50mg/dl), and possible loss of consciousness. Othersassistance treatment.To mark record time needed for standard, standard after different glucose-loweringdaily cost standards (oral glucose-lowering drugs), blood sugar more, Two groups did notsuccess rate (calculate failure rate), treatment of hypoglycaemia occuring in the process of(light, medium, heavy). Follow-up after discharge adhere to treatment time (month), toreflect the compliance of treatment.Using SPSS17.0software for statistical data processing.Results: A, B two groups of blood sugar2hours after lunch, respectively (9.9±1.8)mmol/L,(7.9±1.8) mmol/L，The comparison between groups was statistically difference(p<0.05)；A, B two groups of blood glucose after dinner, respectively (10.5±1.4) mmol/L,(8.7±1.3)mmol/L, The comparison between groups was statistically difference (p<0.05)；A, B two groups of blood sugar2hours after breakfast, respectively (8.8±1.0) mmol/L,(9.0-0.7) mmol/L，Is no statistical difference between groups (P>0.05)；A, B two groupsof midnight3:00blood sugar respectively(5.8±0.7) mmol/L,(6.2±1.0) mmol/L, Is nostatistical difference between groups (P>0.05)； A, B two groups of bloodglucoserespectively (6.7±0.8) mmol/L，(6.6±1.0) mmol/L, Is no statistical differencebetween groups (P>0.05).A group of10cases of no1case of failure, the failure rate is0%.，Group B in12cases with angina during1case was in the hospital, To eliminate thequeue; The remaining11cases,1case of failure, the failure rate is9.1%，Is no statisticaldifference between groups (P>0.05). Incidence of hypoglycemia: A, B two groups of thesame, in1case, the Once symptoms of low blood sugar,the rate of10%，Is no statisticaldifference between groups (P>0.05). Among them, for moderate hypoglycemia group A,group B for mild hypoglycemia.Time used to mark A, B two groups, respectively (7.9+2.6),(8.5-2.8) days, is no statistical difference between groups (P>0.05).To mark A, Btwo groups after the average daily cost of an oral glucose-lowering drug (24.7+9.7) yuan,respectively (29.9+14.6) yuan, is no statistical difference between groups (P>0.05).A, Btwo groups after discharge adhere to treatment time respectively1[1,5),1(1,7] months,comparing the two groups have no statistical difference (P>0.05).Conclusion:1In T2DM treatments, Levemir+oral medications for lunch and dinner afterblood sugar control is superior to the Levemir+NovoRapid.2, Two plans after the incidence of hypoglycemia, time needed for standard, standardaverage cost, compliance to the same.3, Oral medications are not applicable to all patients with T2DM, because there exists aphenomenon of drug intolerance.