甘精胰岛素联合吡格列酮治疗对初发及药物继发失效2型糖尿病患者胰岛功能及糖耐量转归的影响

The effects of Glargine with Pioglitazone and metformin therapy on function of pancreatic islet and glucose tolerance outcomes in newly diagnosed type-2 diabetes and secondary failure to oral agents

目的了解初发2型糖尿病(NDM)及磺脲类降糖药继发失效2型糖尿病(SFDM)患者的胰岛功能及甘精胰岛素联合吡格列酮、二甲双胍治疗后的变化。方法临床设计分为3组:SFDM组80例,NDM组100例及健康对照组40例。治疗前做口服葡萄糖耐量试验(OGTT)、胰岛素释放及C-肽释放试验作为基线对照,甘精胰岛素联合治疗使糖化血红蛋白(HbA1c)水平<7.0%至少6个月,停胰岛素联合治疗3 d后复查治疗前相关指标,3组间进行比较。结果NDM组和SFDM组患者治疗后C-肽释放曲线下面积较治疗前均有明显扩大(P<0.05)。治疗前SFDM组、NDM组C-肽释放峰曲线下面积与对照组相比明显降低(P<0.01),但治疗前2组糖尿病患者的C-肽曲线下面积差异无统计学意义(P>0.05)。治疗后胰岛素、C-肽释放峰值回归正常时相的比例明显升高,而且1 h胰岛素、C-肽与空腹比值也明显升高(P<0.05或0.01)。NDM组结束时正常糖耐量(NGT)/糖耐量减低(IGT)的比例明显多于SFDM组(P<0.01)。结论早期甘精胰岛素并吡格列酮及二甲双胍治疗明显有助于初发2型糖尿病及口服药继发失效的糖尿病患者胰岛功能的恢复,包括口服葡萄糖耐量第一时相胰岛素的分泌,同时可以部分逆转糖耐量状态,初发NDM获益更多。

Objective To evaluate the function of pancreatic islet of newly diagnosed type-2 diabetes（NDM） and secondary sulfonylureas failure（SFDM） and the effects of Glargine with Pioglitazone and metformin therapy therapy on it.Methods All the patients were divided into threegroups： SFDM group（n=80）,NDM group（n=100） and normal control group（C-group,n=40）.C-Peptide and insulin releasing test was performed for the patients in each group with 75 grams of glucose load before and after therapy.Both NDM group and SFDM group should keep their fasting blood glucose（FBG）〈6.1 mmol/L,2 h post-prandial blood glucose（2 h-PBG）〈7.0 mmol/L and glycosylated hemoglobin Alc（HbAlc）〈7% for six months at least.Results TheAUC of C-Peptide releasing increased significantly in NDM group and SFDM group after therapy,as compared with that pre-treatment,with 9.0±3.4vs13.1±3.7（P〈0.05） and 8.5±4.1vs11.9±3.3（P〈0.05）.The AUC of C-peptide releasing reduced significantly in each diabetes group at pre-treatment,as compared with that in control group,with 8.5±4.1、9.0±3.4vs15.5±4.4（P〈0.01）,but there is no significant difference between NDM group and SFDM group（8.5±4.1vs9.0±3.4,P〉0.05）.After therapy,the ratio of the normal phases of C-Peptide and insulin releasing peak in each diabetes group increased significantly,and the ratio of phase60＇to phase0＇in value of insulin/ C-Peptide was also increase.In the end of study,the percentage of NGT or IGT in NDM group was much more than that in SFDM group.Conclusion The function of pancreatic islet including first phase insulin and C-Peptide secretion in oral glucose tolerance test（OGTT） of NDM and SFDM got quite restored to normal by way of Glargine with Pioglitazone and Metformin therapy.Their glucose tolerance state was reversed partially by this combination treatment,but those newly diagnosed type-2 diabetes can derive more benefits from the therapy mode.