预混胰岛素类似物联合中午1次那格列奈治疗老年2糖尿病的效果评价

Effect evaluation of combination therapy of nateglinide added to premixed insulin analogue old type 2 diabetes mellitus

目的探讨每日两次预混胰岛素类似物注射联合二甲双胍治疗的老年2型糖尿病(T2DM)患者,空腹血糖、早餐后2小时血糖持续达标,然而糖化血红蛋白(HbA1c)却不能达标。那格列奈、阿卡波糖进一步降低HbA1c的效果及其安全性。方法采用诺和锐30早餐前和晚餐前注射联合二甲双胍治疗的T2DM老年患者43例,分为两组:A-N组(n=21)开始那格列奈120mg每日1次于午餐前服用,3个月后改为阿卡波糖50mg每日1次于午餐前服用;N-A组(n=22)开始阿卡波糖50mg每日1次于午餐前服用,3个月后改为那格列奈120mg每日1次于午餐前服用。结果治疗结束与基线比较,A-N组和N-A组HbA1c均明显降低,但两组比较差异无统计学意义。与那格列奈相比阿卡波糖的不良反应以胃肠道为主(P<0.01),那格列奈以低血糖为主但与阿卡波糖相比两者差异无统计学意义。结论每日两次注射预混胰岛素类似物联合二甲双胍是T2DM老年患者很常用的降糖方案,但是存在一些缺陷,加用那格列奈或阿卡波糖可以进一步控制血糖,与阿卡波糖相比那格列奈的胃肠道不良反应更少。

Objective To evaluate the effect of combination therapy of nateglinide added to premixed insulin analogue and metformin in old type 2 diabetes mellitus（T2DM） patients. Methods Forty-three T2DM old patients having twice daily injections of premixed insulin analogue （30 % insulin aspart and 70% protamine crystallized insulin aspart） at breakfast and supper combined with metformin,whose fdtsting plasma glucose level was below 6.1 mmol/I., post-breakfast plasma glucose level below 7.8 mmol/L and HbA1c level above 7.0% for more than 3 consecutive months,were divided randomly into two groups. The N-A group was started on nateglinide （120 mg before lunch ） while the A-N group was started on acarbose （50 mg before lunch） without changing their insulin regimen at the time of enrollment. After 12 weeks of either therapy, the drugs were switched and treatment was continued for another 12 weeks. Results After treatment, HbA1 c value decreased significantly in both groups, but the difference between A-N group and N-A group was not significant. The major concerns related to acarbose treatment were gastrointestinal symptoms. Symptoms related to hypoglycemia were scarcely observed with either nateglinide or acarbose treatments. Conclusion Nateglinide is an effective and safe drug in the treatment of T2DM old patients having twice daily injections of premixed insulin analogue combined with metformin,similar to acarbose.