Adding insulin to standard diabetes drugs results in better blood sugar control for many with type 2 diabetes, British researchers report, and the dose and timing of insulin received can make a big difference.

    Specifically, a once-a-day, long-acting dose of insulin may be the best approach for patients making the move to insulin therapy, the study found.

    Keeping blood sugar under control reduces the risk of complications in type 2 diabetes. But diabetes is also a progressive disease, which disrupts insulin production. Consequently, for many diabetes patients, the drugs used to control blood sugar need to be increased repeatedly and most patients will eventually need to take insulin, the researchers said.

    For the study, the researchers compared different forms of insulin therapy for patients with type 2 diabetes. Insulin treatment can start with a "basal" dose that is long-acting, a "prandial" or mealtime dose of insulin that is short-acting or a so-called biphasic dose, a mixture of both short and long-acting insulin.

    However, which of these regimens works best was not clear. To find out, the researchers randomly assigned 708 patients to biphasic insulin injections twice a day （NovoMix30）, mealtime insulin injections three times a day （NovoRapid） or basal insulin injected once a day （Levemir）. All of the formulations are made by Novo Nordisk.

    These patients had poor blood sugar control even though they were taking two common oral diabetes medications, metformin and sulfonylurea, the researchers noted.

    Three years into the trial, the researchers found that slightly more than 43 percent of the patients taking basal insulin and about 45 percent of the patients taking insulin at mealtime achieved good blood sugar control, compared with about 32 percent of those taking biphasic insulin.

    In addition, those on basal insulin had a lower incidence of low blood sugar, a serious side effect of insulin therapy, compared to those on biphasic or mealtime insulin, Holman's team found. Moreover, patients on basal insulin gained less weight than people on the other two regimens.

    Whether lowering blood sugar with insulin and other medications will prevent complications from diabetes, this study was too short to tell. The study was not powered to analyze the so-called hard endpoints, such as eye complications or, most importantly, cardiovascular problems.

    However, there were fewer deaths among those in the study started on basal insulin.

    英國研究人員報告說，常規(guī)糖尿病藥物加上胰島素可更好地控制許多Ⅱ型糖尿病患者的血糖，胰島素用量和接受時間的選擇對結(jié)果影響較大。

    研究發(fā)現(xiàn)，一天注射一次長效胰島素是接受胰島素治療的患者的最佳選擇。

    研究人員說，控制好血糖可降低Ⅱ型糖尿病并發(fā)癥的發(fā)病率。但糖尿病是一種漸進(jìn)性疾病，擾亂胰島素的分泌。因而，降糖藥物用量對于許多糖尿病患者來說，必須一加再加，大多數(shù)患者最終必將接受胰島素治療。

    研究中，研究人員比較了胰島素治療Ⅱ型糖尿病的多種不同治療方法。胰島素治療可以長效"基礎(chǔ)用量"為開始，也可以短效的餐時胰島素或雙相胰島素為開始。所謂的雙相胰島素就是長短效胰島素的混合。

    但是，研究人員并不了解那種方案效果最好。為此，他們隨機指定了708名患者每天接受雙相胰島素注射兩次（諾和銳30）,餐時胰島素注射每日三次（速效胰島素）,或基礎(chǔ)胰島素每日一次（地特胰島素）.所有藥物都是由諾和諾德公司制造的。

    研究人員指出，盡管這些患者還在服用兩種常用的口服藥物――二甲雙胍和磺酰脲類，他們的血糖控制得并不好。

    試驗的第三年，研究人員發(fā)現(xiàn)接受基礎(chǔ)胰島素的患者中有43%稍多的人血糖控制較好；接受餐時胰島素的患者中有大約45%的人血糖控制較好，而接受雙相胰島素的大約32%的人血糖控制較好。

    另外，與接受雙相胰島素或餐時胰島素的患者相比，接受基礎(chǔ)胰島素的患者低血糖發(fā)生率較低，低血糖是胰島素療法的一種嚴(yán)重副作用。此外，接受基礎(chǔ)胰島素的患者比接受另外兩種方案的患者體重增加較小。

    用胰島素加其它藥物來降低血糖是否能防止糖尿病的并發(fā)癥，此研究還不能回答這一問題。這個研究沒有能力分析所謂的硬終點，如眼部并發(fā)癥或最重要的心血管疾病等。

    但是，研究中接受基礎(chǔ)胰島素的患者死亡極少。