艾塞那肽对2型糖尿病患者胰岛素敏感性的影响

The effects of exenatide on insulin sensitivity in type 2 diabetics patients

目的 观察短期艾塞那肽治疗对2型糖尿病患者胰岛素敏感性的作用.方法 42例口服磺脲类药物治疗糖化血红蛋白不达标的2型糖尿病患者,按数字表法随机分为两组；艾塞那肽组20例,甘精胰岛素组22例,各组患者均给予糖尿病常规治疗,继续使用原用药物,同时艾塞那肽组使用艾塞那肽早晚餐前皮下注射,甘精胰岛素组给予甘精胰岛素每晚睡前注射1次,共治疗5个月.治疗前后采用高胰岛素-正葡萄糖钳夹术评价两组胰岛素敏感性,并测定相关代谢指标.结果 与治疗前比较,艾塞那肽组葡萄糖代谢率升高[（5.12±0.35）与（2.94±0.41）]mg· kg-1·min-1,P＜0.05],稳态模型评估胰岛素抵抗指数（HOMA-IR）降低[4.51（1.32 ～6.12）与1.96（1.32 ～6.12）,P＜0.05],体质量指数下降较甘精胰岛素组显著（P＜0.05）；两组均无严重低血糖事件发生.结论 短期艾塞那肽治疗对2型糖尿病患者胰岛素敏感性有改善作用.

Objective To investigate the effects of exenatide on insulin sensitivity in type 2 diabetics.Methods 42 diabetics of secondary failure of sulfonylurea were recruited in the study,and were distinguished to the exenatide group and the glargine group.Besides being treated with diabetic conventional and original treatments,the two groups were given respectively exenatide before breakfast and dinner,or glargine before sleeping by subcutaneous injection for five weeks.Insulin sensitivity of the two groups was elevated by euglycemic-hyperinsulinemic clamps before and after treatment.The metabolic indices were determined.Results Compared with baseline levels,after treatment the glucose metabolic rate was improved [（5.12 ± 0.35） vs （2.94 ± 0.41）] mg · kg-1 · min-1,P 〈 0.05],the BMI and HMOA-IR was reduced[4.51 （1.32 ～ 6.12） vs 1.96 （1.32 ～ 6.12）],in the exenatide groups,which were better than the glargine group （P 〈 0.05）.Gastrointestinal adverse reactions,which were tolerable and decreased,were appeared in nearly 31.42% of subjects.There were no severe hypoglycemic events in both groups.Conclusion Short-term treatment with exenatide could improve the insulin sensitivity of type 2 diabetics.