西格列汀联合二甲双胍治疗初诊2型糖尿病的效果观察

Efficacy studies of sitagliptin combined with mefformin treatment in newly diagnosed type 2 diabetes patients

目的探讨西格列汀联合二甲双胍治疗初诊2型糖尿病的临床效果。方法入选2011年5月至2012年2月我院门诊及住院行口服葡萄糖耐量试验及胰岛素、C肽激发试验初诊为2型糖尿病患者82例，应用随机数字表分为西格列汀组和联合二甲双胍组各41例。82例患者经宣教后给予糖尿病饮食及适度运动锻炼治疗。西格列汀组口服西格列汀100mg、1次／d；联合二甲双胍组给予西格列汀100mg、1次／d，二甲双胍250mg、3次／d口服。共治疗随访6个月。比较治疗前及治疗6个月后体质量指数、糖化血红蛋白以及口服葡萄糖耐量试验中空腹血糖（FPG）、2h血糖（2hPG）、空腹胰岛素、2h胰岛素、空腹C肽、2hC肽等各项指标的变化情况。结果两组治疗后各指标均较治疗前显著降低（P均〈0．05），但联合二甲双胍组治疗后体质量指数、糖化血红蛋白以及FPG、2hPG、空腹胰岛素、2h胰岛素、空腹C肽、2hC肽等指标均显著低于西格列汀组[（27．4±1．2）、（27．9±1．5）kg／m^2，（8．1±1．2）％、（8．8±1．3）％，（8．17±1．22）、（9．22±1．28）mmol／L，（10．16±1．68）、（11．01±1．62）mmol／L，（9．22±1．93）、（9．85±1．59）mU／L，（74．62±13．73）、（83．75±13．12）mU／L，（1．43±0．34）、（1．77±0．27）μg／L，（6．80±1．40）、（7．61±1．64）μg／L]，差异均有统计学意义（t值分别为-2．812、-2．953、-4．940、-3．362、-2．212、-5．235、-3．194、-4．480，P均〈0．05）。结论西格列汀应用于初诊2型糖尿病患者，对于提高患者生活质量、良好控制血糖、改善胰岛素抵抗、减少家庭及社会医疗负担均起到积极作用，如能联用二甲双胍则效果更佳。

Objective To explore the clinical effects of sitagliptin alone or its combination with mefformin on the patients with type 2 diabetes registered on their first clinic/hospital visits. Methods Eighty- two patients with type 2 diabetes who diagnosed with oral glucose tolerance test （OG＇Fr）, insulin test and glucagons stimulating C-peptide test from May 2011 to February 2012 in our hospital were randomly divided into two groups：the patients in control group took sitagliptin alone （control group, n = 41 ） and the patients in experimental group took sitagliptin combined with metformin （experimental group, n = 41 ）. Eighty-two patients, after the mission, were given diabetic diet and moderate exercise therapy. Taking sitagliptin 100 nag, 1 times/d; combined with mefformin groups given sitagliptin 100 rag/d, mefformin 250 mg,3 times/d. Six months later, the major indexes comparing between before and after treatment of weight, body Mass Index （ BMI ）, glycosylated hemoglobin（ HbAlc）, OGTT, fasting plasma glucose （ FPG）, 2 h plasma glucose （ 2 hPG）, fasting insulin （FINS）, 2 h postprandial insulin （2 hlNS）, fasting C-peptide and 2 h postprandial C-peptide levels were measured to research the changes during the treatments. Results After treatments, all the indexes were decreased significantly, and the BMI, HbA1 c, FPG,2 hPG, FINS ,2 bINS, fasting C-peptide and 2 h postprandial C-peptide in the group with sitagliptin united with mefformin were significantly lower than the group with sitagliptin（（27.4±1. 2） kg,/m2 vs. （27.9 ±1.5） kg/m2,t= -2.812;（8.1 ±1.2）% vs. （8.8 ±1.3）%, t = - 2. 953 ; （8. 17 ± 1.22） mmol/L vs. （9. 22 ± 1.28 ） mmoL/L, t = - 4. 940 ; （ 10. 16 ＋ 1.68 ） mmol/L vs. （11.01± 1.62） mmoL/L,t = -3.362;（9.22 ＋ 1.93） mU/L vs. （9.85 ± 1.59） mU/L,t = -2.212; （74. 62 ± 13.73） mU/L vs. （ 83.75 ＋ 13. 12） mU/L, t = - 5. 235 ; （ 1.43 ± 0. 34 ） μg/L vs. （ 1.77 ± 0. 27 ） μg/L, t = - 3. 194 ; （ 6. 80 ± 1.40 ） μg/L vs. （ 7. 61 ± 1.64 ） μg/L, t = - 4. 480 ; P 〈 0. 05 ）. Conclusion Sitagliptin is useful to treat type Ⅱ diabetes, plays important roles in improving patients＇ quality of life and insulin resistance, control of blood glucose, reduce the family and the burden of social health, and the effect willbe more better when united with metformin.