那格列奈联合二甲双胍治疗初发2型糖尿病患者的疗效观察

Efficacy of nateglinide combined with metformin in patients with newly diagnosed drug-naive type 2 diabetes

目的 比较那格列奈和阿卡波糖联合二甲双胍对初发2型糖尿病患者的疗效。方法对我院收治的96例新诊断的2型糖尿病患者随机分别予那格列奈联合二甲双胍（A组，46例）和阿卡波糖联合二甲双胍（B组，42例）治疗4个月，每2周调整一次药物剂量，治疗前后分别行口服葡萄糖耐量试验和胰岛素释放试验，观察糖耐量、稳态模型胰岛素抵抗指数（HOMA—IR）、B细胞分泌功能及葡萄糖处置指数（DI）的变化。结果治疗后，A组有6例恢复为正常糖耐量，13例恢复为糖耐量受损，B组有12例恢复为糖耐量受损；治疗后两组HOMA—IR均较治疗前明显改善，A组从8．6±1．2降至7．1±1．3，B组从8．6±1．7降至6．9±1．7（P〈0．05）；治疗后A组早时相胰岛素分泌较B组明显恢复[（1．9±0．8）与（1．6±0．6）mU／mmol，P〈0．05]；治疗后A组DI较B组明显改善（1．05±0．25与0．89±0．21，P〈0．05）。结论那格列奈联合二甲双胍可显著改善初发2型糖尿病患者胰岛素早时相分泌功能和胰岛素抵抗，促进糖耐量恢复。

Objective To compare efficacy of nateglinide or acarbose combined with metformin in patients with newly diagnosed type 2 diabetes. Methods Ninety-six patients with newly diagnosed type 2 diabetes in Metabolic Diseases Hospital of Tianjin Medical University, were randomly to receive nateglinide combined with metformin （group A, n = 46 ） or acarbose combined with metformin （group B, n = 42） for four months. Drug dose was adjusted every two weeks. Before and after treatment, oral glucose tolerance test and insulin release test were performed to observe changes of their glucose tolerance, homeostasis model assessment for insulin resistance （HOMA-IR） , insulin secretion function of ^-cells and glucose disposition index （DI） in the two groups. Results After four-month treatment, six patients restored to normal glucose tolerance and 13 patients returned to impaired glucose tolerance （IGT） in group A and 12 patients restored to IGT in group B. Their HOMA-IR was markedly improved compared with baseline in both groups, decreased to 7. 1± 1.3 from 8.6 ± 1.2 in group A and to 6. 9 ± 1.7 from 8.6± 1.7 in group B （P 〈 0. 05）. Compared with group B, early insulin secretion （ LN△I30/AG30 ） obviously improved in group A [ （ 1.9± 0.8） vs. （1.6±0.6） mU/mmol] （P〈0.05） and DI also increased （1.05±0.25 vs. 0.89±0.21, P〈 0. 05 ）. Conclusions Nateglinide combined with metformin can obviously restore early insulin secretion and improve insulin resistance in patients with newly diagnosed type 2 diabetes, thus facilitate restoration of their glucose tolerance.