初诊老年糖尿病患者给予小剂量药物与非药物干预的疗效对比

Efficacy of Low-dose Drug Therapy versus Non-pharmacological Intervention for Newly Diagnosed Elderly Diabetes Mellitus

目的:观察对初诊老年糖尿病患者给予小剂量药物治疗与非药物干预的临床疗效,探讨老年糖尿病的治疗。方法:将符合世界卫生组织(WHO)诊断标准且年龄>60岁的90例患者随机分为格列美脲组、瑞格列奈组及非药物干预组,治疗12周,治疗前后检测患者空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)、空腹胰岛素水平(FIns),计算以稳态模型评估的胰岛素抵抗指数(HOMA-IR)等,并进行对比分析。结果:2个药物治疗组在降低FPG、2hPG、HbA1c上明显优于非药物组(P<0.01),且治疗前后患者HOMA-IR明显降低(P<0.05)。在改善脂代谢、低血糖发生率、肝肾损害上3组差异无统计学意义(P>0.05)。结论:本观察中药物治疗组在血糖达标、减轻胰岛素抵抗等方面优于单纯非药物干预,应用的2种药物对老年糖尿病患者较为安全,是老年糖尿病患者降糖药选择及治疗的有益探索,同时提示高龄糖尿病患者的治疗方案更应个体化。

OBJECTIVE ：To evaluate the efficacy of low-dose drug therapy versus non-pharmacological intervention for newly diagnosed elderly diabetes mellitus and to discuss the treatment of elderly patients with diabetes. METHODS ： A total of ninety patients （aged above 60 years） meeting the diagnostic criteria of WHO on diabetes mellitus were randomly assigned to Glimepiride group, Repaglinide group and non-pharmacological intervention group for treatment of 12 weeks. The levels of fasting plasma glucose （FPG） and postprandial plasma glucose （2hPG） , hemoglobinA1 c （HbA1 e）and fasting insulin（Fins） were measured and insulin resistance index was evaluated by homeostatic model assessment of insulin resistance （HOMA-IR） before and after the treatment. A contrastive analysis was performed. RESULTS：After treatment, levels of FPG,2hPG, HbAlc showed significantly better decrease in Glimepiride group and Repaglinide group than in non-pharmacological intervention group （ P 〈 0.01 ） and HOMA-IR were also decreased significantly in Glimepiride group and Repaglinide group as compared with before treatment（P 〈 0.05 ）. There were no statistically significant differences across the three groups regarding the improvement in lipid metabolism, incidence of hypoglycemia and hepatorenal damage. CONCLUSION：The results suggest that Glimepiride and Repaglinide are more effective than non-pharmacological intervention with regard to meeting the target of blood glucose and relieving insulin resistance, and Glimepiride and Repaglinide are safe in elderly patients with diabetes, which thus provide new choice of hypoglycemic drugs and beneficial exploration for drug treatment of diabetes in elderly, furthermore, the results suggest that it is better to adopt individualized therapy for elderly patients with diabetes mellitus.