| Background:Diabetes is one of the most common chronic diseases,and its prevalence is increasing rapidly with the improvement of people’s living standards,population aging,and lifestyle changes.The complications of diabetes are even more serious to human health.Blood glucose management is the basis of diabetes treatment,and ideal blood glucose management is not limited to Hb A1 C and the overall level of blood glucose,and blood glucose fluctuations are closely related to diabetic vascular disease.Clinicians will encounter similar situations in practice.Doubt: The patient’s blood glucose concentration is not particularly high,but chronic complications have occurred very early.Further studies have shown that chronic complications of diabetes are also closely related to blood glucose fluctuations.The unstable state of blood glucose triggers the expression of oxidative stress and inflammatory factors,and is closely related to vascular endothelial injury,apoptosis,atherosclerosis,and islet β cell dysfunction.As a independent risk factor for diabetes,blood glucose drift is more variability.The higher the incidence of complications,the earlier the appearance,the worse the prognosis.Blood glucose fluctuations can predict cardiovascular adverse events and risk of death.Hypoglycemia events and postprandial hyperglycemia are key factors influencing blood glucose fluctuations.Epidemiological investigations have also shown that elevated postprandial plasma glucose(PPG)is the most common clinical manifestation in T2 DM patients in China.As a independent risk factor for diabetes,blood glucose drift is more variability.The higher the incidence of complications,the earlier the appearance,the worse the prognosis.Therefore,how to control blood sugar more smoothly and benefit patients is the most important thing in our diabetes treatment.As one of the important means of diabetes treatment,insulin plays an important role in the clinical treatment of diabetes.There are many different types of insulin in patients,and how to choose patients is one of the problems encountered by every endocrinologist.Insulin can be classified into animal insulin,human insulin,and insulin analog according to chemical structure and source.Since the successful discovery of insulin by Banting and Best in 1921,the development of insulin has never stopped.From the initial animal-derived insulin to human insulin and the widely used insulin analogues in recent years,it has been an effective means of clinical glycemic management.In insulin therapy for diabetic patients in China,premixed islets are widely used in clinical practice because of their ability to combine fasting and postprandial blood glucose.Clinical trials have shown that insulin analogs are superior to human insulin in mimicking the physiological insulin secretion and reducing the risk of hypoglycemia.Bi-phase insulin aspart 30(BIAsp 30)is a more commonly used pre-mixed insulin analog that absorbs faster and peaks higher than bi-phase human insulin 30(BHI 30).BIAsp 30 is better than BHI 30 in controlling postprandial blood glucose in patients and reducing hypoglycemia.Bi-phase insulin aspart 50(BIAsp 50)is a novel high-premixed insulin aspartate preparation.As compared to pre-mixed human insulin 50 R,insulin aspart 50 has a faster onset and a faster peak drop.Blood glucose fluctuations can predict cardiovascular adverse events and risk of death.Hypoglycemia events and postprandial hyperglycemia are key factors influencing blood glucose fluctuations.For high premixed insulin,it is necessary to reduce the blood sugar fluctuations while controlling hyperglycemia after meals,which will inevitably bring about clinical benefits.This study was designed to compare the efficacy and safety of a combination of BIAsp 50-50 and BIAsp 30-30 in combination with metformin twice daily in Chinese T2 DM patients.Objective:This study was designed to compare the efficacy and safety of two injections of BIAsp 50-50 in combination with metformin and twice daily injection of BIAsp30-30 in combination with metformin in Chinese T2 DM patients.Methods:Fifty patients with pre-mixed human insulin-controlled T2 DM were analyzed for a total of 16 weeks,after a 4-week induction period and a 12-week treatment period.Subjects continued their previous insulin therapy during the induction period,and the original oral antidiabetic drug was changed to metformin.After the introduction period,they were randomly assigned to BIAsp 50(A)group or BIAsp 30(B)group for 12 weeks..After 12 weeks of treatment,the baseline levels of FBG,2h PBG and Hb A1 C were significantly decreased in the two groups.After 12 weeks of treatment,the 2h PBG in group A was significantly lower than that in group B,and the blood glucose level after breakfast and after dinner was statistically significant(P<0.05).There were no significant differences in FBG and Hb A1 C levels between the two groups.The number of hypoglycemia events in both groups was very small,and no serious hypoglycemia occurred.The insulin doses were similar and there was no statistical difference.Results:BIAsp50 performed better than BIAsp30 in improving Hb A1 c and PBG,significantly reducing blood glucose fluctuations.Conclusion:We conclude that in clinical practice,individualized glycemic control goals should be established based on the patient’s specific circumstances,and appropriate insulin and dose adjustment protocols should be selected.Compared with the bi-phase insulin aspart 30,the dual-phase insulin aspart 50 regimen can effectively promote Hb A1 C and PPG,and significantly reduce blood glucose fluctuations. |
