杨骏 唐莉

[摘要] 目的 观察门诊患者胰岛素强化治疗对高血糖控制的影响，从而探索难治性糖尿病血糖达标的门诊管理方案。方法 选择2011年5月～2015年6月在本院住院的62例难治性糖尿病患者，出院时血糖基本达标。其中34例为治疗组，出院后继续在门诊维持胰岛素强化治疗，其余28例为对照组，出院后使用口服药物或者2次预混胰岛素治疗。治疗3个月后比较两组患者的血糖控制达标率、低血糖发生事件等情况。 结果 与对照组比较，强化治疗组FPG、2hPG及HbA1c指标控制更平稳（P<0.05），血糖达标率更高（P<0.05），低血糖事件发生率更低（P<0.05）。 结论 多次皮下胰岛素注射强化治疗是难治性糖尿病患者有效、安全的治疗方案，并且此方案适宜在门诊管理和推广。

[关键词] 胰岛素注射；强化治疗；难治性糖尿病；门诊管理

[中图分类号] R587.1 [文献标识码] B [文章编号] 1673-9701（2015）34-0028-03

Clinical observation of multiple subcutaneous insulin injection in the intensive treatment of refractory diabetes in outpatient clinics

YANG Jun TANG Li

Department of Endocrinology， Xuan'en County People's Hospital in Hubei Province Xuan'en 445500， China

[Abstract] Objective To observe the effects of insulin intensive treatment on the control of hyperglycemia in the patients in outpatient clinics， so as to explore the management protocol of blood glucose up to standard in refractory diabetes. Methods A total of 62 patients with refractory diabetes who were hospitalized in our hospital from May 2011 to June 2015 were selected， and their blood glucose level was basically up to standard upon discharge. 34 of them were in treatment group， were further given maintenance intensive insulin therapy in the Outpatient Clinic after discharge， and 28 of them were in the control group， who were given oral medication or 2 times of pre-mixed insulin therapy. The standard rate of blood glucose control and events of hypoglycemia were compared between the two groups of patients 3 months after the treatment. Results There was statistical significance in the comparison between intensive treatment group and control group. The control of FPG， 2hPG and HbA1c indicators was more stable（P<0.05）， the standard rate of blood glucose was higher（P<0.05） and the incidence rate of hypoglycemia was lower （P<0.05）. Conclusion Intensive treatment of multiple subcutaneous insulin injection is an effective and safe treatment protocol for patients with refractory diabetes， and this protocol is appropriate for management and promotion in outpatient clinics.

[Key words] Insulin injection； Intensive treatment； Refractory diabetes； Outpatient management

糖尿病患者长期高血糖通过多种机制损伤胰岛β细胞功能，致使血糖进一步升高而形成恶性循环[1]。胰岛素强化治疗可迅速、有效控制患者的高血糖状态，减轻高血糖对胰岛β细胞的抑制作用[2]，有利于糖尿病患者的长期治疗，然而胰岛素泵价格昂贵，且不易掌握，大部分只能在住院时短期使用，不能广泛用于更多人群[3]，很多难治性糖尿病患者血糖不能得到有效的持久的达标。针对这一问题，我科自2011年开通糖尿病教育门诊，我们在门诊对需要胰岛素治疗、自我管理能力较好的难治性糖尿病患者进行糖尿病健康教育后，采用多次皮下注射胰岛素强化治疗，取得良好的效果。现报道如下。

1 资料与方法

1.1 一般资料

选择2011年5月～2015年6月在本院内分泌科住院的难治性糖尿病患者62例，男52例，女10例。年龄20～73 岁，平均（51.4±5.2）岁，平均病程（8.4±3.2）年。……