甘精胰岛素或格列美脲对初诊T2DM患者胰岛功能影响对比研究

The Effects of Short-term Intensive Therapy with Glargine Versus Glimepiride on β-cell Function in Newly Diagnosed Type 2 Diabetic Patients

目的探讨不同强化治疗方案在短期内严格控制血糖对初诊2型糖尿病患者胰岛β细胞功能的影响。方法20例患者随机分为两组,每组10例,使用甘精胰岛素或格列美脲联合二甲双胍治疗,疗程4周,对其在治疗前后胰岛β细胞功能及血糖控制情况进行自身及组间比较。结果自身比较:治疗后两组空腹、餐后2h血糖、糖化血红蛋白均显著下降(P<0.001);除空腹外,静脉葡萄糖耐量试验各时间点的胰岛素或C肽均升高(P<0.05);胰岛素或C肽曲线下面积、急性胰岛素分泌时相、胰岛素分泌指数均升高(P<0.05)。组间比较:甘精胰岛素组血糖达标时间短于格列美脲组(P<0.01)。结论甘精胰岛素或格列美脲联合二甲双胍的短期强化治疗方案能稳定控制血糖、改善胰岛β细胞功能,且前者可以使血糖更快达标;上述2种方案用于伴有高血糖的早期T2DM患者开始接受降糖药物治疗时简便易行。

Objective To evaluate the effects of two different short - term intensive therapies on β - cell function in newly diagnosed type 2 diabetic patients. Methods Twenty newly diagnosed type 2 diabetic patients were divided into two groups of 10 patients each and randomly treated with glargine or glimepiride plus metformin for 4 weeks. The improvement of β- cell function, FPG, PPG, HbA1 c were measured before and after intensive therapy in each group. The difference in the improvement of β- cell function, blood glucose and the frequency of hypoglycemia were compared between groups. Results After the treatment, FPG （ 12. 25 vs. 6. 05 and 11. 83 vs. 6. 35mmol/L） , 2hPG（ 18.67 vs. 8.11 and 16.95 vs. 8.73mmol/L） , HbA1 c （ 8.98% vs. 7.38% and 9.17% vs. 7.71% ） were significantly decreased （ all P 〈 0. 001 ） in each group. The mean insulin concentrations at each point during IVGTT were increased （ P 〈 0. 05 ） , while the fasting insulin concentration remained unchanged. The area under the curve of insulin （59.66 vs. 122.63 P 〈 0.01 and 59.25 vs. 104.11μU/（ml · min） P〈0.01） and c-peptide （21.70 vs. 29.90 P〈0.01 and 21.04 vs. 30.94ng/（ml · min） P〈 0. 05） , first - phase insulin secretion （ - 1.46 vs. 49.07 and - 0.65 vs. 35.10μU/（ ml · min） , all P 〈 0.05） and Homeostasis model assessment of beta - cell function（ 14.34 vs. 58.82 and 14.69 vs. 60.58, P 〈0.01 ） were increased in each group. The time of achieved optimal glycemic control was shorter in glargine group[ （15.50 ±4.09）vs. （21.42±4.68）day P 〈0.01 ]. Conclusions Short -term intensive therapy with glargine or glimepiride plus mefformin could effectively improve glycemic control and β - cell function, especially the first - phase insulin secretion in newly diagnosed type 2 diabetic patients with hyperglycemia, and the time of achieved optimal glycemic control was shorter in glargine group. Both were simple and convenient approaches easy to carry out at the beginning of treatment.