那格列奈和瑞格列奈在2型糖尿病中对胰岛素的作用

The function of nateglinide and repaglinide on the insulin for the type Ⅱ diabets

目的 :对比那格列奈、瑞格列奈合并二甲双胍用药治疗 2型糖尿病 12周后胰岛素快速分泌相和B细胞分泌胰岛素功能的改变。方法 :6 1个经 4周单用二甲双胍后病例随机分入那格列奈组和瑞格列奈组进行 12周药物治疗。在 0周和 12周检测空腹血糖 (FPG)、餐后 2h血糖 (2hPG)、糖化血红蛋白 (HbA1C)、空腹胰岛素 (FIN)及餐后 1h胰岛素 (1hIN)水平 ,并比较治疗前后胰岛素分泌相改变程度及HOMA IR模型中B细胞功能指数 (HOMA IS)的变化。结果 :(1)两组FPG、2hPG及HbA1C均较治疗前有显著下降 ,P <0 .0 5 ,组间比较差异无显著性。 (2 )以 1hIN与空腹胰岛素FIN比值作为评估胰岛素分泌改变程度指标 ,两组 12周其比值均高于治疗前 ,P <0 .0 5 ,但组间比较无差异 ;治疗后两组HOMA IS显著高于治疗前 ,P <0 .0 5 ,治疗后两组之间无差异。 (3)影响 1hIN /FIN及HOMA IS的主要因素为糖尿病病史。结论 :那格列奈和瑞格列奈与二甲双胍联合治疗 2型糖尿病在降糖、促进胰岛素快速分泌和改善B细胞分泌功能均有显著作用。

OBJECTIVE To compare the effects of nateglinide plus metformin and repaglinide plus metformin on rapid phase of insulin secretion and B cell function in patients with type 2 diabetes.METHODS Enrolled patients ( n =61) with a 4 week metformin run in therapy period were randomized to addition of negalinide or repaglinide for 12 weeks.FPG,FIN and HbA 1C were assessed on fasting state as well as 2 h PG and 1 h IN were assessed after a standard meal at baseline and week 12.RESULTS (1)Final FPG,2 h PG and HbA 1C were significantly lower before than after treatment in both groups, P < 0.05 ,but no significant difference between them.(2)The ratio of 1 h IN and FIN for elevating the secretion of insulin in both groups before treatment is significant lower than after treatment, P < 0.05 ,but no difference of this ratio between these two groups after treatment. AS same as in HOMA IS, P < 0.05 .(3) The history of diabetes is the main factor of the changes of 1 h IN/FIN and HOMA IS.CONCLUSION The addition of nateglinide to metformin and repaglinide to metformin treatment resulted in reductions of FPG,2 h PG and HbA 1C,as well as the increasing of secretion of rapid phase insulin and the function of B cell.But there was no significant difference between netaglinide and repaglinide.The history of diabetes is the predictor of the function of B cell and rapid phase secretion of insulin.