那格列奈和瑞格列奈改善2型糖尿病患者胰岛β细胞功能的比较研究

Comparison between efficacy of nateglinide and repaglinide in improving type 2 diabetes pancreatic β cell function

目的:比较研究那格列奈和瑞格列奈对2型糖尿病患者胰岛β细胞功能的影响。方法:采用随面双盲对照的临床试验,46例2型糖尿病患者分为两组,分别服用那格列奈(270mg/d)或瑞格列奈(3mg/d)12w,测定治疗前后腹、餐后30min、60min、120min血糖和血清胰岛素水平,以及糖化血红蛋白(HbA1c)浓度,计算并比较了Homa-β指数、胰岛素早期分泌指数(IRG)和胰岛素曲线下面积与葡萄曲线下面积比值(AUCi/AUGg)。结果:两组患者治疗后空腹及餐后血糖、HbA1c均降低,治疗前后差异有统计学意义(P<0.05),两组间比较无显著性差异。Homa-β指数在治疗前后和两组间比较均无显著性差异;AUCi/AUCg治疗后两组均升高(P<0.05),但两组间比较无显著性差异;IRG指数治疗后两组均增加(P<0.05),同时那格列奈组的上升幅度较瑞格列奈组更大,差异有显著性(P<0.05)。结论:那格列奈和瑞格列奈均能增加胰岛素的早期分泌,降低2型糖尿病患者血糖和HbA1c水平。在常规剂量下,那格列奈促进早期且岛素分泌的作用可以较瑞格列奈更为明显。

Objective:To compare the efficacy between nateglinide and repaglinide in improving type 2 diabetes pancreatic β cell function.Methods:A double-blind,randomized clinical study was introduced to 46 patients with type 2 diabetes mellitus who were administrated with nateglinide or repaglinide for 12 weeks.Both in the 0 week and the 12th week concentration of the serum insulin,C-peptide and blood glucose,as well as plasma HbA 1c concentration,were measured respectively at preprandial 0 min and postprandial 30,60,120min.Homa-βindex,insulin response to glucose(IRG)and the ratio of the area under curve between insulin and glucose(AUCi/AUCg)were computed for statistical analysis.Results:Compared with 0 week,the levels of blood glucose and plasma HbA 1c all dropped in both groups with statistical significance(P<0.05)at the 12th week,while the differences between the two groups showed no significance.Homa-β index changed little after treatment in both groups.While AUCi/AUCg raised 12 weeks later with no difference between the two groups(P<0.05).As for index IRA,it increased significantly after treatment in both groups(P<0.05),and rose higher in the group administrated with nateglinide than that with repaglinide(P<0.05).Conclusion:Nateglinide and repaglinide both can increase early insulin secretion and lower levels of blood glucose and HbA 1c.Nateglinide is likely to stimulate early insulin release more effectively than repaglinide at conventional dosage.