西格列汀联合胰岛素泵治疗新诊断2型糖尿病血糖波动研究

Effects of add-on treatment with sitagliptin on narrowing the range of glucose fluctuations in patients with newly diagnosed type 2 diabetes mellitus receiving insulin-pump therapy

目的观察西格列汀联合胰岛素泵对新诊断2型糖尿病患者血糖波动的影响。方法 26例新诊断2型糖尿病患者按随机数字表分为单纯胰岛素泵治疗组(CSII组)与西格列汀联合胰岛素泵治疗组(CSII+Sig组),每组各13例,强化治疗2周,最后3 d行72 h动态血糖监测(CGMS),观察平均血糖波动幅度(MAGE)、血糖标准差(SDBG)、最大血糖波动幅度(LAGE)、平均血糖(MBG)。治疗结束时比较胰岛素用量之差(Δ胰岛素)、体重指数变化(ΔBMI)、血糖达标天数。结果 CGMS结果显示:CSII+Sig组与CSII组相比,MAGE(2.83±0.86与4.01±0.54)、SDBG(1.39±0.32与1.99±0.38)、LAGE(5.41±1.43与6.80±1.26)、MBG(6.65±0.39与7.91±0.53)均显著下降(P<0.05)。治疗后比较两组Δ胰岛素(-4.26±6.27与6.5±8.76)、ΔBMI(-0.12±0.38与0.24±0.34)、血糖达标天数(3.92±0.76与5.55±1.29),CSII+Sig组均偏低(P<0.05)。结论西格列汀联合胰岛素泵强化治疗新诊断T2DM患者较单纯胰岛素泵强化治疗而言,具有改善患者血糖波动,减少胰岛素用量,减轻体重,缩短血糖达标天数等优势。

Objective To assess the effects of add-on treatment with Sitagliptin on narrowing the range of glucose fluctua- tions in patients with newly diagnosed type 2 diabetes mellitus （T2DM） receiving insulin-pump therapy. Methods A total of 26 patients with newly diagnosed T2DM were randomly divided into two groups, treated with insulin-pump alone （ CSII group, n = 13 ） or add-on sitagliptin （ CSII ＋ Sig group, n = 13 ） for 2 weeks by random number generation. The mean amplitude of glycaemic excursion （MAGE） ,standard deviation of blood glucose （SDBG） , largest amplitude of glycemic excursions （LAGE） ,and mean blood glucose （MBG） of the patients were measured by a continuous glucose monitoring system （CGMS） for the last three days. The changes of insulin dosage （Ainsulin）, body mass index （ABMI）, and the days of blood glucose up to scratch were compared at the end of treatment. Results The data from CGMS showed the levels of MAGE （2.83 ± 0.86 vs4.01± 0.54）,SDBG （1.39±0.32 vs 1.99 ＋ 0.38）,LAGE （5.41 ± 1.43 vs6.80 ± 1.26） ,and MBG （6. 65 ± 0. 39 vs 7.91± 0. 53） were significantly lower in CSII ＋ Sig group than those in CSII group （ all P 〈 0. 05）. After treatment,the values of Ainsulin （ - 4. 26 ± 6. 27 vs 6. 5 ±8. 76） and ABM1 （ - 0. 12 ± 0. 38 vs 0.24 ± 0.34） were less and the days of blood glucose up to scratch （3.92± 0.76 vs 5.55 ± 1.29） were fewer in CSII ＋ Sig group than those in CSII group （ P 〈 0. 05 ）. Conclusion Add-on treatment with Sitagliptin is effective for improving glucose fluctuations in newly diagnosed T2DM patients receiving insulin-pump therapy, which may be favorable in reduction of insulin dosage, weight gain and the days of hospital stay.