关键词: 2型糖尿病, 持续葡萄糖监测, 持续皮下胰岛素输注, 德谷胰岛素, 血糖变异性

Abstract:

Objective To investigate the glycemic profiles and clinical practicality of transitioning hospitalized patients with type 2 diabetes mellitus （T2DM） from continuous subcutaneous insulin infusion （CSII） to insulin degludec （IDeg）， insulin degludec/aspart （IDegAsp）， or insulin degludec/liraglutide （IDegLira）， and to compare the relative advantages of these post-CSII strategies in terms of achieving glucose targets， glycemic stability， and regimen simplification. Methods This retrospective study recruited hospitalized patients with T2DM who were switched from CSII to one of three degludec-based regimens：IDeg， IDegAsp， or IDegLira. Continuous glucose monitoring （CGM） was employed to assess glycemic outcomes before and after the treatment conversion. Alterations in mean glucose （MG）， glucose management indicator （GMI）， time in range （TIR）， time above range （TAR）， time below range （TBR）， and coefficient of variation （CV） were analyzed and compared among groups. Results All three regimens enabled a clinically stable transition subsequent to the discontinuation of CSII and were linked to an overall improvement in CGM-derived metrics. After the treatment conversion， the MG and GMI decreased， while the TIR increased significantly； simultaneously， the CV and TAR were diminished. The TBR remained largely unchanged in the IDegAsp and IDegLira groups， yet it showed a slight increase in the IDeg group （0.00% ［0.00， 0.01］ vs. 0.01% ［0.00， 0.02］， P = 0.009）. Comparisons between groups further demonstrated that IDegAsp and IDegLira outperformed IDeg， presenting more favorable values for TIR， MG， GMI， CV， TAR， and TBR. Suspected hypoglycemic events detected by CGM were not verified through capillary glucose re-checking. Additionally， 58% of patients receiving IDegLira achieved satisfactory glycemic control with no more than one concomitant glucose-lowering agent. Conclusions For hospitalized patients with T2DM who have completed CSII-based intensive therapy， transitioning to a degludec-based regimen can further enhance glycemic management. Among the evaluated options， IDegAsp and IDegLira demonstrated more favorable overall performance than IDeg in terms of glucose control， reduction of glucose variability， and outcomes related to hypoglycemia. Notably， IDegLira may provide an additional benefit by reducing the complexity of treatment， making it a potentially practical choice for the transition of the regimen after discharge.

Key words: type 2 diabetes mellitus, continuous glucose monitoring, continuous subcutaneous insulin infusion, insulin degludec, glycemic variability