| Background With the improvement of peoples’ living standards, the incidence of diabetes mellitus is increasing year by year worldwide. Patients with type 1 diabetes(T1DM) due to absolute deficiency of insulin need exogenous insulin injection all long life. With the function and mass of islet beta cells decline in type 2 diabetic(T2DM) patients with the prolong duration, only medical nutrition treatment, physical exercise and other lifestyle ajustment, even oral hypoglycemic drug(OHA) treatment are not enough for better glycemic control. Ultimately insulin therapy need to be started. Continuous subcutaneous insulin injection by insulin pump is one of the important methods in insulin intensive treatment. Insulin pump has already entered Chinese market for 15 years. It is estimated the personal long-term pump users are nearly 4 thousand in China. According to the survey of insulin pump users in our country, 44% are type 1 diabetic patients, 54% are type 2 diabetic patients, and the other 2% are caused by other causes. Nearly 3000 hospitals have carried out insulin intensive treatment by insulin bump in regular clinical works till now. It is estimated that patients who have received short-term insulin pump treatment are more than one million. Insulin pump with real-time continuous glucose monitoring, which entered Chinese market in 2012, have been used in major hospitals and some patients. It is believed that patients receiving insulin pump therapy will continuously increase in the future.Objective To analyse the differences of different bolus insulin adjustment methods in insulin intensive treatment regimes on days before good blood glucose control,glycemic excursion,daily insulin dosage and frequency of hypoglycemia, and to seek the most safe and effective methods for in-patient type 2 diabetic patients receiving insulin treatment as soon as possible.Methods Sixty type 2 diabetic patients with hyperglycemia who were accepting premixed insulin injection twice a day with or without oral hypoglycemic agents were recruited from in-patients of the department of endocrinology, the Second Hospital of Ji Lin University during August 2014 to October 2015. All patients’ data including age, sex, duration of diabetes, body height, body weight, body mass index(BMI), blood pressure, fasting plasma glucose(FPG), glycosylated hemoglobin(Hb A1c), plasam C-peptide, blood lipids, liver and kidney function, daily insulin dose were collect before treatment. All the patients were randomly divided into 3 groups:group A:fixed bolus and basal insulin dosage adjustment by 2U every time according doctors’ experience and patients’ blood glucose monitoring by glucose meter. Group B:regulate bolus insulin dosage automaticly according to Bolus Wizard software by insulin bump itself,before which some index such as insulin sensitivity,carbohydrate index and target glucose need to be set up. Group C:the same insulin dosage adjustment methods with group B, and the same time connecting with real-time continuously glucose monitoring system together, and additional bolus insulin given when hyperglycemia happening at any time. The days before blood glucose treat to target, glycemic excursion,daily insulin dosage and frequency of hypoglycemia were recorded after treatment in the three groups. SPSS19.0 statistical software was used for statistical analysis. P<0.05 was determined as a statistically significant difference.Results 1. Age, sex, duration of diabetes, body height, body weight, body mass index(BMI), fasting plasma glucose(FPG), glycosylated hemoglobin(Hb A1c), pancreatic islet function, blood lipids, blood pressure, liver and kidney function have no significant statistical difference in three groups. 2. Days before blood glucose treat to target in group B is significantly less than group A(p<0.05), and days before blood glucose treat to target in group C is significantly less than group B, either(p<0.05). 3. There are significant statistical differences in glucose control and glycemic excursion among three groups. Area under glucose curve is lest in group C,and which in group B is significantly less than group A during the same duration. 4. There was no significant difference in the frequency of hypoglycemia,severe hypoglycemia and nocturnal hypoglycemia among the three groups. 5. The daily insulin dosages after glucose treat-to-target all decrease in group A and group B(P<0.05), while there is no significant difference in group C before and after treatment. The ratio of bolus insulin dose(TDD) was higher than basal insulin dose(TBD) in group C and there was no significant difference between group A and group B. There were no significant differences in average daily insulin dosage among the three groups.Conclusion 1. Multi-metabolic disorders are easily comorbid in patients with type 2 diabetes mellitus related to relative or absolute insulin deficiency and dyslipidemia is the most common seen in the patients. 2. The efficacy was better in group C, in which Bolus Wizard function by insulin pump was applicated in regulation of insulin dosages, than group A and group B, in which groups fixed regulation of insulin dosage according to glucose before meals. Following strict diet plan was good for better glucose control. 3. Bolus Wizard function combined with real-time continuous blood glucose monitoring can shorten the time of blood glucose treat-to-target, reduce the area under the curve of blood glucose, and reduce the glycemic excursion. 4. Bolus Wizard function combined with real-time continuous blood glucose monitoring did not increase the risk of hypoglycemia with better glucose control.5. Application of Bolus Wizard function or fixed regulation of insulin dosage decreased insulin dosage both. While combination Bolus Wizard function with real-time continuous glucose monitoring can not saved insulin dosage and the ratio of bolus insulin dosage to basal insulin dosage increased. |
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