沙格列汀或格列美脲联合甘精胰岛素对2型糖尿病患者血糖波动影响的观察

Effects of saxagliptin or glimepiride combined with glargine on blood glucose fluctuations in type 2 diabetic patients

目的观察沙格列汀联合甘精胰岛素及格列美脲联合甘精胰岛素对T2DM患者血糖波动的影响。方法 60例未接受胰岛素治疗且血糖控制不佳的T2DM患者被随机分为沙格列汀联合甘精胰岛素组和格列美脲联合甘精胰岛素组,共治疗12周。采用动态血糖监测系统(CGMS)监测血糖波动情况,观察BMI、FPG、HbA1c及胰岛素用量等指标。结果两组血糖控制均改善,沙格列汀联合甘精胰岛素组日内血糖平均波动幅度(MAGE)、日内血糖波动次数(NGE)、日间血糖平均绝对差(MODD)低于格列美脲联合甘精胰岛素组[(2.2±1.0)vs(4.1±1.9)mmol/L;(1.4±1.4)vs(2.6±1.5)次/d;(1.30±0.65)vs(2.60±0.90)mmol/L,P<0.05]。两组治疗后FPG及HbA1c均降低[沙格列汀联合甘精胰岛素组(10.5±2.1)vs(6.2±1.3)mmol/L,(8.7±1.2)%vs(6.3±1.1)%;格列美脲联合甘精胰岛素组(10.4±1.8)vs(6.1±1.4)mmol/L,(8.9±1.4)%vs(6.5±1.2)%](P均<0.01);沙格列汀联合甘精胰岛素组BMI低于格列美脲联合甘精胰岛素组[(22.2±2.4)vs(25.5±2.7)kg/m2](P<0.05)。结论沙格列汀联合甘精胰岛素可有效控制血糖,改善血糖波动,在血糖控制稳定性方面优于格列美脲联合甘精胰岛素。

Objective To investigate the effect of saxagliptin plus glargine or glimepiride plus glargine on blood glucose fluctuations in T2DM patients. Methods A total of 60 T2DM patients with unsatisfactory glycemic control who did not receive insulin therapy were randomly assigned to saxagliptin plus glargine group and glimepiride plus glargine group. They were followed up for 12 weeks. During the treatment, continuous glucose monitoring system （CGMS） was used to evaluate the blood glucose fluctuations. BMI, FPG, HbA1 c, insulin dosage and other clinical characteristics were recorded. Results Glycemic control was improved in both groups. Mean amplitude of glycemic excursions （MAGE）, number of glycemic excursion （NGE）, mean of daily differences （MODD） were lower in saxagliptin group than in glimepiride group [（2.24±1.0）vs（4.14±1.9）mmol/L; （1.4±1.4）vs（2.6±1.5） times/d; （1.30±0.65）vs （2.60±0.90） retool/L, P〈0.05]. FPG and HbAlc were decreased after treatment in both groups [-saxagliptin group ; （ 10. 5 ± 2.1 ） vs （ 6.2 ±1.3 ） mmol/L, （ 8.7 4± 1.2 ） % vs （ 6.3± 1.1 ） %glimepiride group： （10.4±1.8）vs（6.1±1.4）retool/L, （8. 9±1.4）~ vs（6.5±1.2）%]. BMI was significantly lower in saxagliptin group than in glimepiride group [ （ 22.2 ± 2.4） vs （ 25.5 ± 2.7 ） kg/m2, P 〈0. 05 ]. Conclusion Saxagliptin plus glargine can effectively control blood glucose level and improve blood glucose fluctuations. Compared with glimepiride plus glargine, blood glucose control is much stable in saxagliptin plus glargine treatment.