强化控糖后加用盐酸吡格列酮治疗2型糖尿病的临床疗效观察

Clinical observation of the efficacy of pioglitazone after intensive glycemic control in the treatment of type 2 diabetes

目的观察强化控糖后加用盐酸吡格列酮治疗2型糖尿病的临床疗效。方法 60例使用口服降糖药物治疗的血糖控制不佳的2型糖尿病患者,入院后先进行胰岛素泵强化控糖治疗,患者血糖达到目标值后(FPG<7.0 mmol/L,2 h PG<10.0 mmol/L),改为三餐前门冬胰岛素联合睡前甘精胰岛素继续强化治疗,1周后按1:1的比例随机分为两组,一组继续使用三餐前门冬胰岛素联合睡前甘精胰岛素治疗(对照组),一组在三餐前门冬胰岛素联合睡前甘精胰岛素的基础上加用盐酸吡格列酮30 mg/日(治疗组)。1～4周我院住院治疗,5～12周门诊随访,若出现FPG及2 h PG明显下降或低血糖反应,则减少胰岛素用量。观察加用盐酸吡格列酮治疗前以及治疗12周时FPG、2 h PG、HbAlc、胰岛素用量、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、体重指数的变化情况。结果 (1)治疗组胰岛素用量明显下降,与加用盐酸吡格列酮治疗前有明显差异(P<0.05);对照组的胰岛素用量治疗前后无明显差异(P>0.05);(2)治疗组与对照组加用盐酸吡格列酮治疗前后FPG、2hPG均无明显差异(P>0.05)。(3)治疗组HbAlc有所下降,与加用盐酸吡格列酮治疗前有明显差异(P<0.05),对照组HbAlc也有所下降,差异明显(P<0.05),但治疗后两组比较无明显差异(P>0.05)。(4)加用盐酸吡格列酮后,治疗组TG下降,HDL-C升高,与同组治疗前相比,差异明显(P<0.05),对照组与治疗前相比差异不明显,组间比较差异有显著性(P<0.05)。结论在强化控糖血糖达标后,加用盐酸吡格列酮继续治疗,可以明显降低患者胰岛素的使用剂量,提高患者的依从性,并且能改善血脂代谢紊乱,对于减少心血管并发症的发生有一定益处。

Objective To observe the clinical efficacy of pioglitazone after intensive glycemic control in treating type 2 diabetes. Method Sixty patients suffering from type 2 diabetes previously treated with oral antihyperglycemic drugs with inadequate glycemic control first received continuous subcutaneous insulin injection. After the plasma glucose levels achieved the goal （FPG 〈 7.0 mmoL/L, 2hPG 〈 10.0 mmoL/L）, the treatment was changed to mealtime insulin aspart combining with bedtime insulin glargine. One week later, patients were randomized in a 1：1 ratio into two groups： the control group only received insulin aspart and insulin glargine, the treatment group took pioglitazone hydrochloride 30 mg per day in addition to insulin aspart and glargine. If FPG or 2hPG decreased too fast or a hypoglycemie reaction happened, the insulin dosage were reduced. The observation period was 12 weeks. We observed the FPG, 2hPG, HbAlo, insulin dosage, triglyceride （TG）, total cholesterol （TC）, high density lipoprotein cholesterol （HDL-C）, and low density lipoprotein cholesterol （LDL-C） in these two groups before randomization and at week 12. Results 1. The insulin dosage was decreased significantly in the trestment group after addition of pioglitazone （ P 〈 O. 05 ）, but no significant difference was observed in the control group （P 〉 0.05 ） ; 2. FPG and 2hPG were not changed significantly in both groups after 12 weeks of treatment. 3. HbAl o declined ,/ignifrcantly in both groups after the treatment （ P 〈 0. 05 ）, but no significant difference was observed between the two groups （ P 〉 O. 05 ）. 4. TG decreased and HDL-C increased significantly in the treatment group after 12 weeks of treatment （P 〈0. 05） ,while no significant difference was observed in the control group, and the TG was significantly lower and HDL-C was significantly higher in the treatment group than those in the control group （P 〈 0. 05 ）. Conclusions After the patients had received the intensive insulin treatment and the plasma glucose has reached the goal, the addition of pioglitaz0ne can significantly decrease the insulin dosage that patients need, improve patient compliance, and at the same time improve lipid metabolism, providing some benefits in reducing the occurrence of cardiovascular complications.