基于动态血糖监测的住院2型糖尿病患者从持续皮下胰岛素输注转换至德谷胰岛素为基础的治疗方案的临床效果比较

doi:10.3969/j.issn.1006-5725.2026.10.004

Abstract

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

CLC Number:

R587.1

Yukun ZHAO,Guojing ZHAO,Ruiqing DONG,Wei QIANG,Hui GUO,Heping LI. A comparative study on clinical outcomes of hospitalized patients with type 2 diabetes mellitus transitioning from continuous subcutaneous insulin infusion （CSII） to insulin degludec-based regimens based on continuous glucose monitoring[J]. The Journal of Practical Medicine, 2026, 42(10): 1712-1719.

Figures/Tables 4

Tab.1

Demographic and clinical characteristics of three patient groups"

项目	IDeg (n = 35)	IDegAsp（n = 37）	IDegLira（n = 38）	F/H/χ²值	P值
年龄（ $x ˉ ? ± ? s$ ）/岁	52.00 ± 16.04	52.06 ± 14.35	56.84 ± 9.54	1.58	0.211
性别				1.46	0.482
男	26（74.3）	31（83.8）	32（84.2）
女	9（25.7）	6（16.2）	6（15.8）
BMI（ $x ˉ ? ± ? s$ ）/（kg/m²）	24.28 ± 3.00	22.86 ± 5.01	25.60 ± 2.45	5.20	0.007
病程[M（P₂₅，P₇₅）]/月	60.00（5.00，180.00）	48.00（12.00，120.00）	90.00（45.00，159.00）	2.79	0.248
HbA_1c（ $x ˉ ? ± ? s$ ）/%	10.78 ± 1.34	10.70 ± 1.32	10.51 ± 1.39	2.56	0.082
糖尿病性肾病	15（42.9）	12（32.4）	8（21.1）	4.00	0.135
糖尿病性视网膜病变	8（22.9）	8（21.6）	4（10.5）	2.30	0.316
周围血管病变	26（74.3）	21（56.8）	37（97.4）	17.25	< 0.001
糖尿病足	2（5.7）	2（5.4）	0（0.0）	2.19	0.334
入院前用药				9.51	0.301
未用药	9（25.7）	14（37.8）	8（21.1）
口服降糖药	13（37.1）	12（32.4）	8（21.1）
胰岛素±口服药	12（34.3）	11（29.7）	19（50.0）
GLP-1RA±口服药	0（0.0）	0（0.0）	9（23.7）
胰岛素+GLP-1RA±口服药	1（2.9）	0（0.0）	2（5.3）
入院前用药种类				9.35	0.155
0	9（25.7）	14（37.8）	8（21.1）
1	12（34.3）	8（21.6）	8（21.1）
2	8（22.9）	6（16.2）	16（42.1）
3种及以上	6（17.1）	9（24.3）	6（15.8）
高血压	7（20.0）	3（8.1）	8（21.1）	2.79	0.248
冠心病	2（5.7）	3（8.1）	4（10.5）	0.57	0.751
脂肪肝	8（22.9）	4（10.8）	12（31.6）	4.77	0.092
糖尿病家族史	8（22.9）	11（29.7）	10（26.3）	0.46	0.796

Tab.1

Tab.2

Fig.1

Fig.2

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项目	胰岛素泵期间			转换后			P值
项目	IDeg（n = 35）	IDegAsp（n = 37）	IDegLira（n = 38）	IDeg（n = 35）	IDegAsp（n = 37）	IDegLira（n = 38）	P₁	P₂	P₃	P₄
GMI/%	8.05±1.29	7.30±0.59	7.35±0.69	7.28±1.18	6.75±0.86	6.59±0.49	0.001	<0.001	<0.001	0.003
MG/（mmol/L）	11.01±3.00	9.27±1.37	9.38±1.60	9.21±2.74	7.99±2.00	7.62±1.14	0.001	<0.001	<0.001	0.003
CV/%	32.66±6.18	32.38±4.96	31.58±6.68	30.60±6.86	27.22±5.76	25.61±5.51	0.045	<0.001	<0.001	<0.001
SD/（mmol/L）	3.57±1.09	2.99±0.54	2.97±0.79	2.81±0.94	2.18±0.72	1.97±0.55	0.001	<0.001	<0.001	<0.001
TIR^*/%	48.67±22.42	63.20±16.10	63.87±17.68	64.44±24.06	78.26±20.44	84.89±12.45	<0.001	<0.001	<0.001	<0.001
TITR^#/%	26.82±19.44	38.51±17.58	40.32±21.61	43.80±24.71	56.86±23.15	61.45±20.58	<0.001	<0.001	<0.001	0.004
TAR^▲/%	50.52±23.13	35.54±16.86	35.52±18.30	34.13±24.22	20.13±21.04	14.64±12.69	<0.001	<0.001	<0.001	<0.001
TBR^● [M（P₂₅，P₇₅）]/%	0.00（0.00，0.01）	0.00（0.00，0.02）	0.00（0.00，0.00）	0.01（0.00，0.02）	0.00（0.00，0.02）	0.00（0.00，0.01）	0.009	0.929	0.972	0.020
TIR-TITR/%	21.85±9.01	24.69±5.64	23.55±8.14	20.64±10.05	21.40±12.27	23.44±11.19	0.441	0.145	0.939	0.543
LBGI	1.62±1.30	1.74±1.82	1.17±1.08	1.99±1.32	1.64±1.28	1.07±0.69	0.237	0.729	0.442	0.004
HBGI	15.20±10.21	9.39±3.31	9.67±4.28	10.07±8.83	6.06±5.49	4.49±2.40	0.005	<0.001	<0.001	0.002
ADRR	14.20±10.45	8.38±3.48	8.67±4.19	9.08±8.79	5.53±5.31	3.76±2.26	0.006	0.002	<0.001	0.002
MODD（mmol/L）	3.22±1.11	2.75±0.68	2.76±0.84	2.56±0.97	2.06±0.93	1.74±0.52	0.002	<0.001	<0.001	<0.001
CV_夜间/%	24.38±8.41	25.75±8.07	25.67±9.07	24.27±10.33	21.93±8.34	17.77±5.69	0.961	0.041	<0.001	0.025
CV_白天/%	32.66±6.18	31.83±4.62	31.22±6.49	29.66±6.23	27.04±5.15	25.24±4.68	0.002	<0.001	<0.001	0.014
CV_FBS/%	37.43±26.49	37.17±13.75	28.10±10.77	26.49±12.73	21.07±8.84	21.18±9.35	0.003	<0.001	0.006	0.139

A comparative study on clinical outcomes of hospitalized patients with type 2 diabetes mellitus transitioning from continuous subcutaneous insulin infusion （CSII） to insulin degludec-based regimens based on continuous glucose monitoring

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