摘要目的:评估采用2型糖尿病短期胰岛素强化治疗临床专家指导意见（简称《意见》）对2型糖尿病住院患者的血糖管理效果。方法:2017年11月至2018年12月，选取全国参与《意见》培训的30家医院的320例接受基础加餐时4针胰岛素强化治疗的2型糖尿病（T2DM）患者，将320例患者分为遵循意见组（206例）和未遵循意见组（114例），其中遵循意见组遵循《意见》进行强化治疗，未遵循意见组未按照《意见》中的强化治疗方案进行治疗。每天7次行指尖血血糖监测，根据指血血糖调整胰岛素剂量；同时开始佩戴扫描式葡萄糖监测（FGM）系统，维持7~14 d。观察两组患者的血糖波动和血糖在目标范围内时间（TIR），并采用独立样本 t检验、χ2检验或Fisher精确概率法比较。 结果:遵循意见组血糖波动指标血糖水平的标准差（SDBG）、餐后血糖波动幅度（PPGE）、最大血糖波动幅度（LAGE）、日间血糖平均绝对差（MODD）均低于未遵循意见组，但差异无统计学意义（ P均>0.05）。遵循意见组和未遵循意见组TIR≥70%的患者比例第1天分别为19%和17%、第2天分别为21%和22%，第4天分别为33%和26%，第7天分别为45%和36%，遵循意见组多高于未遵循意见组，且随着治疗时间延长，趋势越发明显。在血糖达标率方面，治疗期间两组的血糖达标率均逐日提高，但达标率和达标速度遵循意见组均优于未遵循意见组，第3、4、5、6、7天两组的血糖达标率分别为14%和6%、21%和10%、24%和14%、36%和12%、38%和22%。血糖控制水平，治疗第7天，遵循意见组的空腹血糖水平更低，分别为7.0和7.7 mmol/L。血糖达标时，遵循意见组基础胰岛素占比在40%~60%的比例逐日下降，第3、4、5、6、7天时分别为93%、90%、76%、60%、59%；未遵循意见组则呈现上升趋势。 结论:遵循《意见》有助于改善血糖达标，但是对血糖波动无明显改善。

abstractsObjective:To evaluate the effect of Clinical Expert Guidance on Short-term Intensive Insulin Therapy for type 2 diabetes mellitus(T2DM)on blood glucose management in hospitalized patients with T2DM.Method:From November 2017 to December 2018, 320 with T2DM who accepted intensive treatment of basal plus bolus insulin from 30 hospitals participating in the "Guidance" training were selected and divided into the compliance group (206 cases) and the non-compliance group (114 cases). The compliance group followed the "Guidance" for intensive treatment, and the non-compliance group did intensive treatment without following the "Guidance". Finger-tip blood glucose was monitored 7 times per day, insulin dose was adjusted according to the blood glucose. Flash glucose monitoring (FGM) system was started at the Day 1 and lasted for 7 to 14 days. The blood glucose fluctuation and time of blood glucose within target range (TIR) of the two groups were observed and compared by independent sample test, Chi-square test or Fisher exact probability method.Results:The standard deviation of blood glucose level, postprandial glucose excursion (PPGE), largest amplitude of glycemic excursions (LAGE) and absolute mean daily difference (MODD) in the compliance group were lower than those in the non-compliance group, but there was no statistical differences ( P>0.05). The proportions of patients with TIR ≥ 70% were 19% and 17% on the first day, 21% and 22% on the second day, 33% and 26% on the fourth day, and 45% and 36% on the seventh day respectively in the compliance group and the non-compliance group. The proportion of patients with TIR ≥ 70% in the compliance group was higher than that in the non-compliance group, and the trend became more obvious with the extension of treatment time. The blood glucose control rates of the two groups both increased day by day during the treatment, but the control rates and speed of achieving the glucose target in the compliance group were superior than those in the non-compliance group. On the third, fourth, fifth, sixth and seventh day, the blood glucose control rates of the two groups were 14% and 6%, 21% and 10%, 24 and 14%, 36% and 12%, 38% and 22%, respectively. On the 7th day of treatment, the fasting plasma glucose level in the compliance group was lower than non-compliance group, 7.0 mmol/L and 7.7 mmol/L, respectively. After the blood glucose achieved the target, in the compliance group, the proportions of patients whose basal insulin dose accounted for 40% to 60% of the whole day insulin dose decreased day by day, were 93%, 90%, 76%, 60% and 59% on the 3rd, 4th, 5th, 6th and 7th day, respectively, however, it showed an upward trend in the non-compliance group. Conclusion:The management adhering to the "Guidance" is helpful to improve the blood glucose control, but there is no significant improvement in blood glucose fluctuation.