Oral antidiyabetik tedavi ile kan şekeri regüle edilememiş tip 2 diyabetli hastalarda tedaviye insülin glargin ve tek doz insülin glulisin eklenmesinin etkinliğinin retrospektif olarak değerlendirilmesi
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Date
2012-04-10
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Uludağ Üniversitesi
Abstract
Biri metformin olmak kaydıyla en az iki oral antidiyabetik ilaç (OAD=Oral Anti-diabetic Drug) ile kan şekeri regüle olmayıp (Hemoglobin A1c= HbA1c= %7-10) bazal-plus insülin tedavisi alan tip 2 diabetes mellitus (T2DM) tanılı hastalar retrospektif olarak değerlendirildi. İncelenen 78 hasta dosyasından 15 hastanın bazal-plus tedavi aldığı ve devam ettiği belirlendi. Sabah açlık kan şekeri değerlerine göre insülin glargin (17:00’de) başlanıp titre edildiği, takiplerinde en yüksek postprandiyal kan şekeri değerlerine göre akşam öğününe insülin glulisin eklenip titre edildiği görüldü. İnsülin glargin sonrası sabah açlık, tokluk, gece 23:00 ve 02:00 kan şekeri değerlerinde, insülin glulisin sonrası akşam tokluk ve gece 23:00 kan şekeri değerlerinde anlamlı düşüş saptandı. HbA1c’de %8.3’ten %6.8’e anlamlı düşüş saptanırken (p<0.001), hipoglisemi ve kilo artışında anlamlı değişiklik saptanmadı. Sonuçta OAD ile kan şekeri regülasyonu sağlanamayan hastalarda bazal-plus insülin tedavisinin yan etki artışı yapmadan etkili kan şekeri regülasyonu ve HbA1c düşüşü sağladığı belirlendi. Bu sonuçlarla bazal-plus tedavisinin intensif insülin tedavisine geçişte uygun bir basamak olduğu kanaatine varıldı.
Patients with the diagnosis of type 2 diabetes mellitus who had unregulated blood glucose (HbA1c=hemoglobin A1c=7-10%) while receiving at least 2 oral antidiabetic drugs and having basal-plus treatment added were evaluated retrospectively. Among 78 patient files examined, it was noted that basal-plus insulin therapy was started and continued in 15 patients. Insulin glargin was started at 17:00 and titrated according to fasting blood glucose values in the morning. It was noted that insulin glulisin was started and titrated at dinner preprandially with the highest postprandial blood glucose values. After insulin glargine, blood glucose levels of fasting and postprandial in the morning, 23:00 and 02:00 at night, after the insulin glulisine, blood glucose levels of dinner postprandial and 23:00 at night were significantly decreased. A significant reduction in HbA1c from 8.3% to 6.8% was detected (p<0.001), hypoglycemia and weight gain didn’t change significantly. As a result, it was demonstrated that in patients who had blood glucose unregulated with OAD, basal-plus insulin therapy provided effective regulation of blood glucose and HbA1c reduction without side effects. With these results the treatment of basal-plus insulin therapy was concluded as an appropriate step in intensifying insulin treatment.
Patients with the diagnosis of type 2 diabetes mellitus who had unregulated blood glucose (HbA1c=hemoglobin A1c=7-10%) while receiving at least 2 oral antidiabetic drugs and having basal-plus treatment added were evaluated retrospectively. Among 78 patient files examined, it was noted that basal-plus insulin therapy was started and continued in 15 patients. Insulin glargin was started at 17:00 and titrated according to fasting blood glucose values in the morning. It was noted that insulin glulisin was started and titrated at dinner preprandially with the highest postprandial blood glucose values. After insulin glargine, blood glucose levels of fasting and postprandial in the morning, 23:00 and 02:00 at night, after the insulin glulisine, blood glucose levels of dinner postprandial and 23:00 at night were significantly decreased. A significant reduction in HbA1c from 8.3% to 6.8% was detected (p<0.001), hypoglycemia and weight gain didn’t change significantly. As a result, it was demonstrated that in patients who had blood glucose unregulated with OAD, basal-plus insulin therapy provided effective regulation of blood glucose and HbA1c reduction without side effects. With these results the treatment of basal-plus insulin therapy was concluded as an appropriate step in intensifying insulin treatment.
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Keywords
Tip 2 DM, OAD, Bazal insülin, Bazal-plus, Kısa etkili insülin, Type 2 DM, Basal insülin, Basal-plus, Short-acting insülin
Citation
Ersoy, C. vd. (2012). "Oral antidiyabetik tedavi ile kan şekeri regüle edilememiş tip 2 diyabetli hastalarda tedaviye insülin glargin ve tek doz insülin glulisin eklenmesinin etkinliğinin retrospektif olarak değerlendirilmesi". Uludağ Üniversitesi Tıp Fakültesi Dergisi, 38(2), 85-89.