米格列奈与瑞格列奈对新诊断2型糖尿病的临床疗效研究

Clinical efficacy of mitiglinide and repaglinide in treatment of patients with newly diagnosed type 2 diabetes mellitus

目的比较米格列奈与瑞格列奈对新诊断2型糖尿病患者(T2DM)在糖代谢、心血管危险因子、氧化应激方面的影响,了解米格列奈药物的短期和中期疗效。方法 2010年4月至2011年1月在我院新诊断90例T2DM患者按随机数字表法分为A、B组(n=45),A组给予瑞格列奈+二甲双胍,B组给予米格列奈+二甲双胍,应用动态血糖监测系统(CGMS)记录3 d内的动态血糖水平和波动趋势,之后12周定期随访相应指标。结果 2组治疗后3 d,空腹血糖、3餐后平均血糖(MBG)及日内血糖平均水平均较治疗前降低,B组餐后1 h及2 h MBG降幅大于A组(P<0.05),平均血糖波动幅度(MAGE)小于A组(P<0.05);12周后,2组空腹及餐后1、2 h血糖均明显降低,B组降幅大于A组;空腹及餐后1、2 h胰岛素(FINS、1 h INS、2 h INS)不同程度升高,B组1 h INS、2 h INS增幅大于A组;B组降低HbA1c幅度大于A组;2组均能降低胰岛素抵抗指数(HOMA-IR)、升高胰岛素敏感指数(ISI),B组优于A组(P<0.05);B组低血糖发生人次低于A组。2组均能不同程度降低总胆固醇(TC)、甘油三酯(TG)、纤维蛋白原(FG)水平,升高高密度脂蛋白胆固醇(HDL-c)水平,2组对纤溶酶原激活物抑制因子-1(PAI-1)下降作用均不明显(P>0.05);B组降低超氧化物歧化酶(SOD)、升高丙二醛(MDA)优于A组(P<0.05)。结论米格列奈与瑞格列奈均能在短期内降低新诊断T2DM患者的血糖,但米格列奈组平均血糖波动幅度小;中期治疗后,与瑞格列奈比较,米格列奈能更好地提高糖化血红蛋白达标率,降低低血糖发生率,改善氧化应激因子。

Objective To compare the effect of mitiglinide and repaglinide on glycometabolism, cardiovascular risk factors and oxidative stress in patients with newly diagnosed type 2 diabetes mellitus （T2DM）. Methods Ninety newly diagnosed T2DM patients were randomly assigned to group A and group B. The patients of group A received repaglinide plus metformin treatment, while those of group B were given mitiglinide plus metformin treatment. Continuous glucose monitoring system （CGMS） was used to record the dynamic changes and fluctuation of blood glucose in all patients during the first 3 days. All the patients were followed up to examine the corresponding indices after 12 weeks. Results After treatment for 3 days, the fasting blood glucose （ FBG）, mean blood glucose （MBG） at 30 rain, and 1, 2 and 3 h after meals, and 24 h MBG decreased in both groups. The decrease of 1 h MBG and 2 h MBG was more significant in group B than in group A （ P 〈 0.05 ）, while the mean amplitude of glycemic excursion （ MAGE ） was significantly lower in group B than in group A （ P 〈 O. 05 ）. Twelve weeks later, FBG and postprandial blood glucose （ 1 h PBG and 2 h PBG） significantly decreased in both groups （ P 〈 0.05 ） , and the decrease in group B was more significant than that in group A （P 〈 0.05 ）. Fasting insulin （FINS） and postprandial insulin （ 1 h INS and 2 h INS） increased in both groups, and the increase of 1 h INS and 2 h INS was more significant in group B than in group A （P 〈0.05）. Glycosylated hemoglobin-Ale（ HbAI~ ） in both groups decreased （P 〈0.05）, and the decrease was more significant in group B than in group A. Both groups could significantly decrease the level of HOMA insulin resistance （HOMA-IR） and increase the level of insulin sensitive index （ISI） （P 〈 O. 05 ） , and the effect was more significant in group B than in group A （ P 〈 0.05 ）. The proportion of hypoglycemia in group Bwas lower than that in group A. Both groups could partly decrease the levels of total cholesterol （TC）, triglycerides （TG） and fibrinogen （FG）, and increase the level of high-density lipoprotein cholesterol （HDL-c）. However, they had no significant effect on plasminogen activator inhibitor-1 （PAI-1） （P 〉 0.05）. Both groups could decrease the level of superoxide dismutase （SOD） and increase the level of malondialdehyde （ MDA）, and the effect was more significant in group B than in group A （P 〈 0.05 ）. Conclusion For newly diagnosed T2DM, both mitiglinide and repaglinide can decrease FBG and PBG significantly in a short term, but mitiglinide can keep MAGE more steadily. After a long period of therapy, mitiglinide can significantly decrease the levels of cardiovascular risk factors and suppress antioxidative stress with lower incidence of hypoglycemia as compared with reDaglinide..