Abstract：
OBJECTIVE: Multiple daily injection (MDI) insulin therapy is an effective method of glycemic control and appropriate assignment to MDI therapy could minimize the risks of hypoglycemia and weight gain. The aim of the present study was to identify factors associated with indication for MDI therapy in type 2 diabetes (T2DM).
METHODS: We recruited 360 participants with T2DM that were admitted to the Endocrinology Department of Peking University People\'s Hospital between August 2017 and July 2018. They first underwent intensive insulin therapy, then were switched to an optimized, simpler insulin treatment that aimed to maintain fasting blood glucose between 4.4 and 7.2 mmol/L, without episodes of hypoglycemia. The baseline characteristics of groups administering either MDI or basal/premix insulin were compared and multivariable logistic regression analysis was used to determine the odds ratios (ORs) for factors associated with MDI therapy. Receiver operating characteristic (ROC) curves were then used to identify independent predictors of MDI insulin regimen efficacy.
RESULTS: The mean age of the participants was 57.6 ± 12.9 years, and diabetes duration was 14.2 ± 8.2 years. Two hundred and sixty-seven participants administered basal/premix insulin and 93 underwent MDI therapy, of whom 61.8% and 46.2% were male, respectively (p = 0.01). The duration of diabetes was significantly longer in the MDI group (13.1 ± 7.7 years vs. 17.3 ± 8.7 years; p < 0.01). Fasting plasma glucose (FPG) was higher in the MDI group than in the basal/premix group (8.3 [6.7, 11.3] mmol/L vs. 7.2 [5.7, 9.3] mmol/L; p < 0.01), while the postprandial C-peptide concentration (PCP) was significantly lower in the MDI group (2.6 [1.8, 3.5] ng/mL) compared to the basal/premix group (3.6 [2.5, 6.2] ng/mL, p < 0.01. Multivariable logistic regression analysis suggested that diabetes duration and FPG were positively associated with MDI therapy: OR (95% confidence interval [CI]) 1.06 (1.02, 1.10) and 1.12 (1.02, 1.24), respectively. In addition, PCP was negatively associated with MDI therapy (0.72 [0.60, 0.86]). ROC analysis suggested that a PCP of < 3.1 ng/mL predicted MDI therapy with 59.6% sensitivity and 72.1% specificity.
CONCLUSIONS: The results of our study suggest that longer diabetes duration, higher FPG, and lower PCP were associated with necessity for MDI insulin regimen. These findings should assist with the personalization of insulin treatment.
METHODS: We recruited 360 participants with T2DM that were admitted to the Endocrinology Department of Peking University People\'s Hospital between August 2017 and July 2018. They first underwent intensive insulin therapy, then were switched to an optimized, simpler insulin treatment that aimed to maintain fasting blood glucose between 4.4 and 7.2 mmol/L, without episodes of hypoglycemia. The baseline characteristics of groups administering either MDI or basal/premix insulin were compared and multivariable logistic regression analysis was used to determine the odds ratios (ORs) for factors associated with MDI therapy. Receiver operating characteristic (ROC) curves were then used to identify independent predictors of MDI insulin regimen efficacy.
RESULTS: The mean age of the participants was 57.6 ± 12.9 years, and diabetes duration was 14.2 ± 8.2 years. Two hundred and sixty-seven participants administered basal/premix insulin and 93 underwent MDI therapy, of whom 61.8% and 46.2% were male, respectively (p = 0.01). The duration of diabetes was significantly longer in the MDI group (13.1 ± 7.7 years vs. 17.3 ± 8.7 years; p < 0.01). Fasting plasma glucose (FPG) was higher in the MDI group than in the basal/premix group (8.3 [6.7, 11.3] mmol/L vs. 7.2 [5.7, 9.3] mmol/L; p < 0.01), while the postprandial C-peptide concentration (PCP) was significantly lower in the MDI group (2.6 [1.8, 3.5] ng/mL) compared to the basal/premix group (3.6 [2.5, 6.2] ng/mL, p < 0.01. Multivariable logistic regression analysis suggested that diabetes duration and FPG were positively associated with MDI therapy: OR (95% confidence interval [CI]) 1.06 (1.02, 1.10) and 1.12 (1.02, 1.24), respectively. In addition, PCP was negatively associated with MDI therapy (0.72 [0.60, 0.86]). ROC analysis suggested that a PCP of < 3.1 ng/mL predicted MDI therapy with 59.6% sensitivity and 72.1% specificity.
CONCLUSIONS: The results of our study suggest that longer diabetes duration, higher FPG, and lower PCP were associated with necessity for MDI insulin regimen. These findings should assist with the personalization of insulin treatment.
摘要：
目的：每日多次注射（MDI）胰岛素治疗是一种有效的血糖控制方法，适当分配MDI治疗可以最大程度地减少低血糖和体重增加的风险。本研究的目的是确定与2型糖尿病（T2DM）MDI治疗适应症相关的因素。
方法：我们招募了2017年8月至2018年7月北京大学人民医院内分泌科收治的360名T2DM患者。他们首先接受了胰岛素强化治疗，然后切换到优化的，更简单的胰岛素治疗旨在维持空腹血糖在4.4和7.2mmol/L之间，没有低血糖发作。比较使用MDI或基础/预混胰岛素组的基线特征，并使用多变量逻辑回归分析确定与MDI治疗相关因素的比值比（OR）。然后使用受试者工作特征(ROC)曲线来鉴定MDI胰岛素方案功效的独立预测因子。
结果：参与者的平均年龄为57.6±12.9岁，糖尿病病程为14.2±8.2年。两百六十七名参与者接受了基础/预混胰岛素治疗，93名参与者接受了MDI治疗，其中61.8%和46.2%为男性，分别(p=0.01)。MDI组的糖尿病持续时间明显更长（13.1±7.7年与17.3±8.7岁；p<0.01）。MDI组的空腹血糖（FPG）高于基础/预混组（8.3[6.7，11.3]mmol/Lvs.7.2[5.7,9.3]mmol/L;p<0.01),而MDI组（2.6[1.8,3.5]ng/mL）的餐后C肽浓度（PCP）显着低于基础/预混物组（3.6[2.5,6.2]ng/mL，p<0.01。多变量logistic回归分析提示糖尿病病程和FPG与MDI治疗呈正相关:OR(95%置信区间[CI])1.06(1.02,1.10)和1.12(1.02,1.24),分别。此外,PCP与MDI治疗呈负相关(0.72[0.60,0.86])。ROC分析提示<3.1ng/mL的PCP预测MDI治疗具有59.6%的敏感性和72.1%的特异性。
结论：我们的研究结果表明，较长的糖尿病病程，更高的FPG，和较低的PCP与MDI胰岛素治疗方案的必要性相关。这些发现应有助于胰岛素治疗的个性化。
方法：我们招募了2017年8月至2018年7月北京大学人民医院内分泌科收治的360名T2DM患者。他们首先接受了胰岛素强化治疗，然后切换到优化的，更简单的胰岛素治疗旨在维持空腹血糖在4.4和7.2mmol/L之间，没有低血糖发作。比较使用MDI或基础/预混胰岛素组的基线特征，并使用多变量逻辑回归分析确定与MDI治疗相关因素的比值比（OR）。然后使用受试者工作特征(ROC)曲线来鉴定MDI胰岛素方案功效的独立预测因子。
结果：参与者的平均年龄为57.6±12.9岁，糖尿病病程为14.2±8.2年。两百六十七名参与者接受了基础/预混胰岛素治疗，93名参与者接受了MDI治疗，其中61.8%和46.2%为男性，分别(p=0.01)。MDI组的糖尿病持续时间明显更长（13.1±7.7年与17.3±8.7岁；p<0.01）。MDI组的空腹血糖（FPG）高于基础/预混组（8.3[6.7，11.3]mmol/Lvs.7.2[5.7,9.3]mmol/L;p<0.01),而MDI组（2.6[1.8,3.5]ng/mL）的餐后C肽浓度（PCP）显着低于基础/预混物组（3.6[2.5,6.2]ng/mL，p<0.01。多变量logistic回归分析提示糖尿病病程和FPG与MDI治疗呈正相关:OR(95%置信区间[CI])1.06(1.02,1.10)和1.12(1.02,1.24),分别。此外,PCP与MDI治疗呈负相关(0.72[0.60,0.86])。ROC分析提示<3.1ng/mL的PCP预测MDI治疗具有59.6%的敏感性和72.1%的特异性。
结论：我们的研究结果表明，较长的糖尿病病程，更高的FPG，和较低的PCP与MDI胰岛素治疗方案的必要性相关。这些发现应有助于胰岛素治疗的个性化。
