格列吡嗪控释片对磺脲类药物疗效不佳的2型糖尿病患者的疗效观察

The efficacy of glipizide XL in the treatment of type 2 diabetic patients unresponding to sulfaurea drugs

目的:评价口服磺脲类降糖药物效果不佳改用格列吡嗪控释片或加用睡前中效胰岛素治疗对糖尿病患者的治疗效果。方法:142例口服磺脲类药物治疗的2型糖尿病患者随机分为4组:A组原磺脲类治疗组;B组改用格列吡嗪控释片治疗组;C组格列吡嗪控释片加睡前胰岛素组;D组原磺脲类加睡前胰岛素组。治疗12周后观察血糖、胰岛素水平和糖化血红蛋白的改变。结果:在4组中,格列吡嗪控释片加胰岛素组和磺脲类降糖药物加胰岛素组治疗效果最好,改用格列吡嗪控释片血糖较原治疗组有所改善,糖化血红蛋白降低,而维持原磺脲类治疗组效果不理想。格列吡嗪控释片加胰岛素组服药依从性好,不良反应少,低血糖发生率低。结论:对于原磺脲类药物治疗不达标患者,换用格列吡嗪控释片治疗具有较好的服药依从性和满意度,治疗效果优于换药前,且可以降低糖化血红蛋白水平,值得临床推广。加用胰岛素睡前注射治疗可更好地控制血糖(包括空腹和餐后血糖),降低胰岛素和糖化血红蛋白水平,但低血糖发生率增多,在临床应用中应加以注意。

Objective: To evaluate the therapeutic effects of ghpizide XL with/without insulin on patients with type 2 diabetes unresponding to anti-diabetic sulfaurea drugs. Methods: One hundred and forty-two diabetic patients receiving sulfau rea drugs were divided into 4 groups randomly: group A, maintaining sulfaurea drugs therapy; group B, using ghpizide XL to replace sulfaurea drugs; group C, using ghpizide XL and bedtime insulin to replace sulfaurea drugs; group D, sulfaurea drugs and bedtime insulin. The levels of serum glucose, insulin and glycosylated hemoglobin (HbA(?)) of all patients were measured before and after 12 weeks of treatment. Results: Of the 4 groups, patients in groups C and D receiving insulin therapy improved most obviously and their serum glucose was well controlled as compared with that in group A. The effectiveness of group B was better than that of group A. The levels of serum glucose and HbA(?) were lower in group B than those in group A. The good compliance and low incidences of side drug reactions and hypoglycemia were observed in group C. Conclusion: Anti-diabetic therapy of ghpizide XL with/without insulin is more effective than sulfaurea therapy and showes good compliance and low incidence of side effects, but attention should be paid to hypoglycemia in the groups C and D.