高醣化血色素值可以預測未接受胰島素治療的第二型糖尿病個案，使用基礎胰島素一年後血糖控制不易達標

High Glycosylated Hemoglobin Level Predicts Unsuccessful Glycemic Target Attainment with Basal Insulin in Insulin-naïve Patients with Type 2 Diabetes

林世鐸(Shi-Dou Lin) ； 許上人(Shang-Ren Hsu)

《內科學誌》 26卷4期 (2015/08) Pp. 206-212

https://doi.org/10.6314/JIMT.2015.26(4).07

摘要

雖然基礎胰島素是第二型糖尿病病人，使用口服抗糖尿病藥物而療效不佳時，經常加上的藥物，但其血糖控制並不一定能達標。本研究目的是找出在口服藥物合併基礎胰島素治療的情況下，血糖控制無法達標（A1C ＜ 7%）的預測因子。我們收集從2005年1月至2006年12月間第一次開始使用基礎胰島素，並持續治療一年的第二型糖尿病個案共415位，收集胰島素使用前及一年後的基本資料進行分析。個案的年齡為60.9 ± 11.9歲，糖尿病罹病年為11.4 ± 6.7年，且已使用2.6±0.6種的口服藥 ( 數值以平均值± 標準差為表示)。使用基礎胰島素一年後，空腹血糖值從223.2 ± 62.8 mg/dL降至149.3 ± 54.8 mg/dL，A1C從10.1 ± 1.8%降至8.8 ± 1.7%，基礎胰島素的起始劑量為0.23 ± 0.12 U/kg/day，最終劑量為0.37 ±0 .21 U/kg/day，使用一年後約9 成不達標。使用胰島素前的A1C值與血糖控制不達標的相關性最好，ROC曲線下面積為0.69，而A1C臨界值設定為8.9%時，其敏感度、特異性及陽性預測值分別為0.772，0.565及0.934。本研究結果建議，第二型糖尿病病人若已接受積極的口服抗糖尿病藥物治療且療效不佳（A1C ≥ 8.9%）時，即使再加上基礎胰島素，其血糖控制無法達標的可能性是相當高的。

關鍵字

基礎胰島素 ； 血糖控制達標 ； 口服抗糖尿病藥物 ； 預測 ； 第二型糖尿病

並列摘要

Although basal insulin is the most frequently added medication for treatment of type 2 diabetes when oral anti-antidiabetic drug (OAD) therapy is inadequate, it does not always achieve optimal glycemic control. This study investigated the factors predicting failure to attain glycemic target with added basal insulin. We enrolled 415 patients who first began basal insulin therapy between January 2005 and December 2006 and continued the therapy for one year. The age, duration of diabetes and number of OADs taken by each patient were 60.9 ± 11.9 years, 11.4 ± 6.7 years, and 2.6 ± 0.6, respectively (mean ± standard deviation). The fasting blood glucose level decreased from 223.2 ± 62.8 mg/dL to 149.3 ± 54.8 mg/dL and A1C level from 10.1 ± 1.8% to 8.8 ± 1.7% after 1 year of basal insulin therapy. Basal insulin dosage was 0.23 ± 0.12 U/kg/day initially and was 0.37 ± 0.21 U/kg/day by the study end. Nearly 90% of patients failed to reach the glycemic target. Glycemic target non-attainment (A1C ＞ 7%) had best correlation with the patient's pre-insulin therapy A1C level (area under ROC curve = 0.69), which, at the cut-off value of 8.9%, had optimal sensitivity, specificity and positive predictive value of 0.772, 0.565 and 0.934, respectively. The result suggests type 2 diabetic patients who are poorly controlled (with A1C ＞ 8.9%) despite rigorous OAD treatment will very likely not attain glycemic target even after adding basal insulin therapy.

並列關鍵字

Basal insulin ； Glycemic target attainment ； Oral anti-diabetic drugs ； Prediction ； Type 2 diabetes