Clinical Efficacy Of Insulin Degludec/Insulin Aspart In The Treatment Of Type 2 Diabetes Mellitus

ObjectiveTo investigate the clinical efficacy of insulin degludec/insulin aspart in the treatment of type 2 diabetes mellitus.MethodsFrom June 2020 to April 2022 patients with type 2 diabetes mellitus who were treated with insulin degludec/insulin aspart in the Second Hospital of Lanzhou University were selected as the research subjects.The observation period was 52 weeks,and the observation points were before conversion,12 weeks,26 weeks,and52 weeks of conversion,respectively.They were divided into 3 groups according to previous treatment regimens,as follows:1.Conversion of oral antidiabetic drug regimen to insulin degludec/insulin aspart once daily regimen: seventy-six patients with type 2 diabetes mellitus who were poorly controlled by oral antidiabetic drug were randomly divided into biphasic 1group(38 cases,insulin degludec/insulin aspart injected before the main meal)and control group(38 cases,insulin glargine injected before bedtime),and all of whom were combined with oral antidiabetic drug.The changes of fasting plasma glucose,2hours postprandial glucose,2 hours fingertip glucose after main meal,glycosylated hemoglobin,glycosylated hemoglobin compliance rate,composite endpoint compliance rate,time in range,triglyceride-glucose index,body weight,incidence of hypoglycemia,daily insulin dose and oral antidiabetic drug type were observed in the biphasic 1 group and the control group before conversion,at 12 weeks,26 weeks and52 weeks of conversion.Comparison of insulin treatment experience questionnaire score at 4 weeks of conversion between the two groups.2.Conversion of basic insulin regimen to insulin degludec/insulin aspart once daily regimen: type 2 diabetes mellitus patients with poor glycemic control treated with basic insulin were converted to insulin degludec/insulin aspart therapy(biphasic2 group,56 cases,injected before the main meal),and all of whom were combined with or without oral antidiabetic drug.The changes of fasting plasma glucose,2 hours postprandial glucose,2 hours fingertip glucose after main meal,glycosylated hemoglobin,glycosylated hemoglobin compliance rate,composite endpoint compliance rate,time in range,triglyceride-glucose index,body weight,incidence of hypoglycemia,daily insulin dose,oral antidiabetic drug type were observed before conversion,at 12 weeks,26 weeks and 52 weeks of conversion,and insulin treatment experience questionnaire scores were observed before conversion,4 weeks after conversion.3.Conversion of intensive insulin regimen to insulin degludec/insulin aspart twice daily regimen: A total of 76 patients with type 2 diabetes mellitus were included in the study,divided into two groups: 56 patients in the biphasic 3a group(type 2diabetes mellitus patients with poor glycemic control treated with premixed insulin were converted to daily insulin degludec/insulin aspart injected before breakfast and dinner),and 20 patients in the biphasic 3b group(type 2 diabetes mellitus patients with poor glycemic control treated with three short and one long were converted to daily insulin degludec/insulin aspart injected before breakfast and dinner).And all of whom were combined with or without oral antidiabetic drug.The changes of fasting plasma glucose,2 hours postprandial glucose,2 hours fingertip glucose after main meal,glycosylated hemoglobin,glycosylated hemoglobin compliance rate,composite endpoint compliance rate,time in range,triglyceride-glucose index,body weight,incidence of hypoglycemia,daily insulin dose,oral antidiabetic drug type were observed in both groups before conversion,at 12 weeks,26 weeks and 52 weeks of conversion,and insulin treatment experience questionnaire scores were observed before conversion,4 weeks after conversion.Results1.Conversion of oral antidiabetic drug regimen to insulin degludec/insulin aspart once daily regimen:(1)Fasting plasma glucose,2 hours postprandial glucose,2 hours fingertip glucose after main meal and glycosylated hemoglobin in the biphasic 1 group were significantly lower than those at baseline after 12 weeks,26 weeks,and 52 weeks of conversion respectively,with statistically significant differences(P<0.05).Fasting plasma glucose,2 hours fingertip glucose after main meal,and glycosylated hemoglobin in the control group were significantly lower than those at baseline after12 weeks,26 weeks,and 52 weeks of conversion respectively,and 2 hours postprandial glucose were significantly lower than that at baseline after 52 weeks of conversion,with statistically significant differences(P<0.05).In the biphasic 1 group,2 hours fingertip glucose after main meal was significantly lower than the control group after 12 weeks of conversion,and the 2 hours fingertip glucose after main meal was lower in those whose main meal were breakfast than in the control group at 12 weeks and 26 weeks of conversion,with statistically significant differences(P<0.05).The differences in fasting plasma glucose,2 hours postprandial glucose,and glycosylated hemoglobin between the biphasic 1 group and the control group were not statistically significant(P>0.05).(2)Time in range was significantly higher than that at baseline,and triglyceride-glucose index was significantly lower than that at baseline in the biphasic1 group and the control group after 12 weeks,26 weeks and 52 weeks of conversion respectively,with statistically significant differences(P<0.05).Compared with the control group,time in range was significantly higher in the biphasic 1 group after 26 weeks and 52 weeks of conversion respectively,and the differences were statistically significant(P<0.05).(3)Compared with the control group,insulin treatment experience questionnaire score was significantly higher in the biphasic 1 group,with a statistically significant difference(P<0.05).(4)There were no significant differences in glycosylated hemoglobin compliance rate,composite endpoint compliance rate,body weight,body mass index,incidence of hypoglycemia,daily dose of insulin,and oral antidiabetic drug type in the biphasic 1group and the control group before conversion,after 12 weeks,26 weeks and 52 weeks of conversion(P>0.05).2.Conversion of basic insulin regimen to insulin degludec/insulin aspart once daily regimen:(1)Fasting plasma glucose,2 hours fingertip glucose after main meal and glycosylated hemoglobin were significantly lower than those at baseline in the biphasic 2 group after 12 weeks,26 weeks,and 52 weeks of conversion respectively,and 2 hours postprandial glucose was significantly lower than that at baseline after 26 weeks,and 52 weeks of conversion respectively(P<0.05).And fasting plasma glucose at 52 weeks of conversion was significantly lower than that at 12 weeks of conversion;and 2 hours postprandial glucose,2 hours fingertip glucose after main meal and glycosylated hemoglobin at 26 weeks and 52 weeks of conversion respectively were significantly lower than those at 12 weeks of conversion,with statistically significant differences(P<0.05).Compared with those whose main meal were lunch or dinner,2 hours postprandial fingertip glucose of those whose main meal were breakfast was significantly lower at 52 weeks of conversion,and the differences were statistically significant(P<0.05).(2)Time in range was significantly higher than that at baseline,and triglyceride-glucose index was significantly lower than its at baseline in the biphasic 2group after 12 weeks,26 weeks and 52 weeks of conversion respectively,with statistically significant differences(P<0.05).(3)Daily insulin dose was significantly higher than that at baseline in the biphasic 2 group after 12 weeks,26 weeks,and 52 weeks of conversion respectively,with statistically significant differences(P<0.05).(4)Oral antidiabetic drug type was significantly fewer than that at baseline in the biphasic 2 group after 52 weeks of conversion,with a statistically significant difference(P<0.05).(5)Insulin treatment experience questionnaire score after conversion was significantly higher than that at baseline in the biphasic 2 group,with a statistically significant difference(P<0.05).(6)There were no significant differences in glycosylated hemoglobin compliance rate,composite endpoint compliance rate,body weight,body mass index and incidence of hypoglycemia in the biphasic 2 group before conversion,after 12 weeks,26 weeks and 52 weeks of conversion(P>0.05).3.Conversion of intensive insulin regimen to insulin degludec/insulin aspart twice daily regimen:(1)Fasting plasma glucose,2 hours fingertip glucose after main meal and glycosylated hemoglobin were significantly lower than those at baseline in the biphasic 3a group after 12 weeks,26 weeks,and 52 weeks of conversion respectively,and the differences were statistically significant(P<0.05).Fasting plasma glucose and glycosylated hemoglobin were significantly lower than those at baseline in the biphasic 3b group after 12 weeks,26 weeks of conversion respectively,and 2 hours fingertip glucose after main meal was significantly lower than that at baseline after 12 weeks,26 weeks,and 52 weeks of conversion respectively,with statistically significant differences(P<0.05).The differences between the two groups were not statistically significant(P>0.05).(2)Time in range was significantly higher than that at baseline and triglyceride-glucose index was significantly lower than that at baseline in the biphasic3 a group after 12 weeks,26 weeks and 52 weeks of conversion respectively,with statistically significant differences(P<0.05).Time in range was significantly higher than that at baseline in the biphasic 3b group after 12 weeks,26 weeks of conversion respectively,with statistically significant differences(P<0.05).The differences between the two groups were not statistically significant(P>0.05).(3)Incidence of hypoglycemia was significantly lower than that at baseline in the biphasic 3a group after 12 weeks and 52 weeks of conversion respectively,with statistically significant differences(P<0.05).(4)Daily insulin dose was significantly lower than that at baseline in the biphasic3 a group after 12 weeks,26 weeks,and 52 weeks of conversion respectively,with statistically significant differences(P<0.05).Daily insulin dose was significantly lower than that at baseline in the biphasic 3b group after 12 weeks,26 weeks of conversion respectively,with statistically significant differences(P<0.05).The difference between the two groups was not statistically significant(P>0.05).(5)Insulin treatment experience questionnaire scores after conversion were significantly higher than those at baseline in the biphasic 3a group and the biphasic 3b group,with statistically significant differences(P<0.05).The difference between the two groups was not statistically significant(P>0.05).(6)There were no significant differences in glycosylated hemoglobin compliance rate,composite endpoint compliance rate,body weight,body mass index and oral antidiabetic drug type in the biphasic 3a group and the biphasic 3b group before conversion,after 12 weeks,26 weeks and 52 weeks of conversion(P>0.05).Conclusions1.Conversion of oral antidiabetic drug to insulin degludec/insulin aspart results in better control of 2 hours fingertip glucose after the main meal,elevates time in range,and also improves the perception of insulin treatment experience,without significant increase in body weight,incidence of hypoglycemia,daily insulin dose,compared with insulin glargine.2.Conversion of basal insulin to insulin degludec/insulin aspart significantly reduces fasting plasma glucose,2 hours postprandial glucose,2 hours fingertip glucose after main meal,glycosylated hemoglobin,elevates time in range,reduces triglyceride-glucose index,reduces oral antidiabetic drug type,improves the perception of insulin treatment experience,and does not cause significant changes in body weight and incidence of hypoglycemia.3.Conversion of intensive insulin to insulin degludec/insulin aspart significantly reduces fasting plasma glucose,2 hours fingertip glucose after main meal,glycosylated hemoglobin,elevates time in range,reduces daily insulin dose,improves the perception of insulin treatment experience,and does not cause significant changes in body weight.Conversion of premixed insulin to insulin degludec/insulin aspart also reduces triglyceride-glucose index,incidence of hypoglycemia.4.For type 2 diabetes mellitus patients with poor glycemic control treated with oral antidiabetic drug and insulin,or unwilling to receive more than twice daily insulin injections,insulin degludec/insulin aspart has good efficacy and safety,and has clinical application value.