Abstract:

Objective To evaluate efficacy and safety of long-acting or intermediate-acting insulin combined with oral hypoglycemic drug in treatment of patients with high blood sugar early after kidney transplantation. Methods 45 cases at 1 month after kidney transplantation with high blood glucose were divided into three groups according to insulin used，insulin detemir group（A），insulin glargine group（B）and Novolin N group（C），and 15 patients in each group. The original oral acarbose dose was maintained，and each group of patients received 1 dose a day injections of insulin for 4 weeks. Blood glucose and incidence of hypoglycemia were monitored. Results Fasting blood glucose and post prandial blood sugar after treatment of three groups were significantly decreased，with most

significantly decreased in the A group ；and A，B groups decreased more than C group〔fasting blood glucose （mmol/L）：3.08±0.51，2.86±0.58 vs. 0.92±0.34 ；post prandial blood sugar（mmol/L）：4.38±1.19，4.18±1.22 vs. 2.34±0.77〕，the difference was statistically significant（all P＜0.05）；A，B groups of hypoglycemia events were obviously less than group C（6%，13% vs. 26%）. Conclusions In patients early after kidney transplantation with high blood glucose and cannot be controlled well by acarbose，treatment with addition of long-acting or intermediate- acting insulin can decrease the level of blood glucose obviously. Insulin detemir is effective and gentle for control forblood glucose with less incidence of hypoglycemia，which is a more ideal physiological simulated insulin secretion.

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摘要：

目的 评价长效或中效胰岛素联合口服降糖药治疗肾移植术后早期高血糖患者的疗效和安全 性。方法 45 例肾移植术后 1 个月高血糖患者按使用胰岛素种类分为 3 组，地特胰岛素组（A）、甘精胰岛 素组（B）、诺和灵 N 组（C），每组各 15 例。所有患者在原口服阿卡波糖药量不变的基础上每天注射 1 次 胰岛素，治疗 4 周，观察 3 组患者的血糖控制及低血糖发生情况。结果 3 组患者治疗后空腹血糖和餐后 血糖都明显下降，其中以 A 组下降最明显；且 A、B 组的下降幅度均大于 C 组〔空腹血糖（mmol/L）：3.08± 0.51、2.86±0.58 比 0.92±0.34，餐后血糖（mmol/L）：4.38±1.19、4.18±1.22 比 2.34±0.77〕，差异均有统 计学意义（均 P＜0.05）；A、B 组低血糖发生明显少于 C 组（6%、13% 比 26%）。结论 肾移植术后早期 血糖高且单用阿卡波糖不能良好控制血糖的患者，加用长效或中效胰岛素治疗，均能达到明显的降糖效果。 地特胰岛素能有效平缓地控制血糖，低血糖发生少，是更为理想的模拟生理分泌的胰岛素。

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