二甲双胍治疗初发2型糖尿病及糖耐量异常者的疗效观察

Metformin in the treatment of patients with newly diagnosed type 2 diabetes and impaired glucose tolerance

目的探讨二甲双胍对初发2型糖尿病(T2DM)及糖耐量异常(IGT)者的疗效。方法初发T2DM、IGT患者各30例,健康志愿者30例,分别设为T2DM组、IGT组及正常对照组,比较各组血糖、糖化血红蛋白(HbA1c)、血脂、血压、体质量指数(BMI)、腰臀比(WHR)、尿酸(UA)、血浆脂联素及内脂素的差异。T2DM组及IGT组患者在合理膳食和适当运动的同时加服二甲双胍1500mg/d,疗程为1年,检测治疗前后各项指标的变化。用酶联免疫吸附法检测血浆脂联素、内脂素水平;血总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-c)、低密度脂蛋白胆固醇(LDL-c)和UA用全自动生化仪测定;空腹血糖(FPG)和糖负荷后2h血糖(2hPG)采用葡萄糖氧化酶法,HbA1c测定采用高压液相法。结果①与对照组相比,IGT组及T2DM组BMI、TC、FPG、2hPG和HbA1c显著增高(P<0.01,P<0.05),脂联素和内脂素水平明显降低(P<0.05,P<0.01);②二甲双胍治疗后,T2DM组BMI、WHR、TC、FPG、2hPG和HbA1c较治疗前明显降低(P<0.05或P<0.01),IGT组BMI、WHR、LDL-c、TC、FPG和2hPG显著降低(P<0.05或P<0.01),但两组脂联素均明显高于治疗前(P<0.01,P<0.05)。结论初发T2DM及IGT患者在生活方式改善的同时服用二甲双胍干预治疗疗效明确。

Objective To investigate the curative effect of Meffonnin on patients with type 2 diabetes mellitus （T2DM） and im- paired glucose tolerance （IGT）. Methods Plasma glucose, HbAlc, blood lipid, blood pressure, body mass index （BMI）, waist hip ratio （WHR）, uric acid （UA）, plasma adiponectin and visfatin levels were detected in 30 cases of T2DM or IGT and 30 healthy subjects. The T2DM group and IGT groups were given a rational diet and appropriate exercises while 1 500 mg/d met- fonnin was administrated lasting for 1 year. Changes of the above indexes before and after treatment were detected. Plasma adi- ponectin and visfatin levels were assayed by ELISA. Blood total cholesterol（TC）, triglyceride, high-density/ipoprotein cholesterol （HDL-c）, low-density lipoprotein cholesteml（LDL-c）, and UA were detected by automatic biochemical apparatus. Fasting plas- ma glucose （FPG） and 2 h plasma glucose （2hPG） were assayed by the glucose oxidase method. Hbhlc was determined by the high pressure lipid phase method. Results Compared with the controls, BMI, TC, FPG, 2hPG and HbAlc were significantly higher in T2DM and IGT patients （ P 〈 0.01 or P 〈 0.05）, while adiponectin and visfatin levels were significantly lower （ P 〈 0.01, P 〈 0.05）. In the IGT group, BMI, WHR, LDL-c, TC, FPG, and 2hPG were significantly reduced after treatment （P 〈0.01 or P 〈0.05）. In the T2DM group, BMI, WHR, TC, FPG, 2HPG, and HbA1c were also significantly lower than before（ P 〈 0.01 or P 〈 0.05）. However, the adiponectin level was significantly higher after treatment in the two groups （P〈0.01, P〈0.05）. Conclusion Mefformin is effective for newly diagnosed T2DM and IGT while lifestyle modification is for management.