基础起始,正当其时重庆ppt课件.ppt

Subject: Fasting Plasma Glucose 6 to 12 Weeks After Starting Insulin Glargine Predicts Success in Reaching A1c≤7.0% at Weeks 24-28 37% 35% 随机,开放,平行实验,纳入756名未用过胰岛素的超重T2DM患者，HbA1c7.5%－10%。 患者在原有OADs基础上随机接受睡前注射来得时或NPH治疗6个月，目标FBG 5.5mmol/L。 这些患者用一种或两种口服降糖药治疗 （磺脲类、二甲双胍、噻唑烷二酮单药或联合治疗），既往未曾用胰岛素治疗，A1c在7.5%-10%。患者在原有口服药物的基础上随机接受睡前注射来得时或NPH。研究结束时，两组患者的血糖水平都得到控制，两组平均A1c均为6.94%。有57%的患者达到了A1C?7%的目标。但是两组的低血糖的情况如何呢 ? The treat-to-target trial: randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients. Riddle MC, Rosenstock J, Gerich J; Insulin Glargine 4002 Study Investigators. Source Oregon Health and Science University, Portland, Oregon 97201, USA. riddlem@ohsu.edu Abstract OBJECTIVE: To compare the abilities and associated hypoglycemia risks of insulin glargine and human NPH insulin added to oral therapy of type 2 diabetes to achieve 7% HbA(1c). RESEARCH DESIGN AND METHODS: In a randomized, open-label, parallel, 24-week multicenter trial, 756 overweight men and women with inadequate glycemic control (HbA(1c) 7.5%) on one or two oral agents continued prestudy oral agents and received bedtime glargine or NPH once daily, titrated using a simple algorithm seeking a target fasting plasma glucose (FPG) or=100 mg/dl (5.5 mmol/l). Outcome measures were FPG, HbA(1c), hypoglycemia, and percentage of patients reaching HbA(1c) or=7% without documented nocturnal hypoglycemia. RESULTS: Mean FPG at end point was similar with glargine and NPH (117 vs. 120 mg/dl [6.5 vs. 6.7 mmol/l]), as was HbA(1c) (6.96 vs. 6.97%). A majority of patients ( approximately 60%) attained HbA(1c) or=7% with each insulin type. However, nearly 25% more patients attained this without documented nocturnal hypoglycemia (or=72 mg/dl [4.0 mmol/l]) with glargine (33.2 vs. 26.7%, P 0.05). Moreover, rates of other categories of symptomatic hypoglycemia were 21-48% lower with glargine. CONCLUSIONS: Systematically titrating bedtime basal insulin added to oral therapy can safely ac