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.

    英国研究人员报告说，常规糖尿病药物加上胰岛素可更好地控制许多Ⅱ型糖尿病患者的血糖，胰岛素用量和接受时间的选择对结果影响较大。

    研究发现，一天注射一次长效胰岛素是接受胰岛素治疗的患者的最佳选择。

    研究人员说，控制好血糖可降低Ⅱ型糖尿病并发症的发病率。但糖尿病是一种渐进性疾病，扰乱胰岛素的分泌。因而，降糖药物用量对于许多糖尿病患者来说，必须一加再加，大多数患者最终必将接受胰岛素治疗。

    研究中，研究人员比较了胰岛素治疗Ⅱ型糖尿病的多种不同治疗方法。胰岛素治疗可以长效"基础用量"为开始，也可以短效的餐时胰岛素或双相胰岛素为开始。所谓的双相胰岛素就是长短效胰岛素的混合。

    但是，研究人员并不了解那种方案效果最好。为此，他们随机指定了708名患者每天接受双相胰岛素注射两次（诺和锐30）,餐时胰岛素注射每日三次（速效胰岛素）,或基础胰岛素每日一次（地特胰岛素）.所有药物都是由诺和诺德公司制造的。

    研究人员指出，尽管这些患者还在服用两种常用的口服药物――二甲双胍和磺酰脲类，他们的血糖控制得并不好。

    试验的第三年，研究人员发现接受基础胰岛素的患者中有43%稍多的人血糖控制较好；接受餐时胰岛素的患者中有大约45%的人血糖控制较好，而接受双相胰岛素的大约32%的人血糖控制较好。

    另外，与接受双相胰岛素或餐时胰岛素的患者相比，接受基础胰岛素的患者低血糖发生率较低，低血糖是胰岛素疗法的一种严重副作用。此外，接受基础胰岛素的患者比接受另外两种方案的患者体重增加较小。

    用胰岛素加其它药物来降低血糖是否能防止糖尿病的并发症，此研究还不能回答这一问题。这个研究没有能力分析所谓的硬终点，如眼部并发症或最重要的心血管疾病等。

    但是，研究中接受基础胰岛素的患者死亡极少。