胰岛素联合西格列汀治疗2型糖尿病患者临床观察

Therapeutic effect of sitagliptin combined insulin in treatment of type 2 Diabetes

目的 探讨胰岛素联合西格列汀治疗单用胰岛素血糖控制不佳的2型糖尿病患者的临床疗效.方法 将80例单用胰岛素、体质量指数（BMI） ≥24 kg/m2、血糖控制不理想的2型糖尿病患者抽签法分成两组：联合组（胰岛素＋西格列汀）40例,在使用胰岛素的基础上应用西格列汀100 mg/d口服,根据血糖水平适时调整胰岛素用量；胰岛素组40例,继续应用胰岛素治疗.比较治疗12周后两组患者的体质量指数（BMI）、空腹血糖（FBG）、餐后2h血糖（2 h PBG）、糖化血红蛋白（HbA1c）、胰岛β细胞功能指数（HOMA-β）、胰岛素抵抗指数（HOMA-IR）、胰岛素用量及低血糖发生率的变化.结果 治疗12周后,两组血糖、HbA1c、HOMA-IR均下降；HOMA-β升高；胰岛素组BMI增加,联合组BMI未增加,两组间同期比较差异有统计学意义（P＜0.05）；治疗12周后,联合组胰岛素用量减少,而胰岛素组用量继续增加,组间同期及组内治疗前后比较差异均有统计学意义（P＜0.05）.结论 胰岛素治疗血糖控制不理想的2型糖尿病患者加用西格列汀可使血糖得到良好控制,同时可以减少胰岛素剂量,减少低血糖发生率,不增加体质量,更好地控制血糖,治疗安全有效.

Objective To explore the clinical effect of sitagliptin combined insulin compared to those patients whose sugars were not well controlled by insulin alone. Methods The eighty type 2 Diabetes patients whose BMI≥24 kg/m2 and used insulin alone were randomly divided into sitagliptin combined insulin group （40 cases） who were given sitagliptin 100mg/d allied with insulin, an insulin group （40 cases） who were given insulin alone. After 12 weeks, the change of body mass index （ BMI）, fasting plasma glucose （FPG）, 2 h postprandial blood glucose （2 h PBG）, glycosylated hemoglobin （HbA1 c）, β-cell function index （HOMA-β）, insulin resistance index （HOMA-IR）, insulin quantities, and hypoglycemia rates were observed in two groups. Results Compared with pretherapy, the levels of FPG, 2 h BG, HbAlc, HOMA-IR, and hypoglycemia rates were significantly decreased （ P 〈 0. 05） ; BMI was increased in insulin group, while was not increased in sitagliptin combined insulin group. After the treatment, the insulin quantities were decreased in the combined group while increased in the control group （ P 〈 0. 05）. Conclusions Sitagliptin combined insulin can effectively control glucose levels of type 2 diabetes patients, decrease the insulin quantities and the risk of hypoglycemia, and does not increase the weight.