西格列汀对大剂量胰岛素控制不佳的2型糖尿病患者的疗效观察

Effect Observation of Itagliptin Combined with Large-dose Insulin on Poorly Controlled Type 2 Diabetes Patients

目的观察西格列汀对大剂量胰岛素控制不佳的2型糖尿病(T2DM)患者的疗效。方法选取80例单用胰岛素(诺和锐+甘精胰岛素)、每日胰岛素总量>50 U、糖化血红蛋白(Hb A1c)≥7.0%患者,将其随机分成胰岛素+西格列汀组与胰岛素组,每组各40例。观察治疗前后两组患者的体重指数(BMI)、空腹血糖(FBG)、餐后2 h血糖(2h PG)、Hb A1c、全天最高血糖最低血糖差值(ΔMMBG)、全天平均餐后最高血糖(MPMG)、胰岛素用量及低血糖发生的频次。结果治疗12周后,两组患者FBG、2h PG、Hb Alc均较治疗前明显下降(P<0.05),但组间比较无统计学意义(P>0.05)。治疗12周后,胰岛素+西格列汀组ΔMMBG、MPMG、胰岛素用量均较胰岛素组明显减少,差异有统计学意义(P<0.05)。治疗前后胰岛素+西格列汀组BMI无明显改变,但胰岛素组BMI较前增加,治疗后两者BMI组间比较有统计学意义(P<0.05)。胰岛素+西格列汀组低血糖发生的频次较胰岛素组明显减少(P<0.05),组间比较有统计学意义(P<0.05)。结论大剂量胰岛素治疗血糖控制不理想的T2DM患者加用西格列汀可使血糖得到良好控制,且可减少胰岛素剂量,不增加体重,同时可以减少血糖波动和低血糖发生。

Objective To observe the effect of sitagliptin combined with large- dose insulin on poorly controlled type 2 diabetes patients. Methods 80 patients selected with a single- use insulin（ aspart insulin and glargine）,a total of daily insulin more than 50 u and a Hb A1 c more than 8% were randomly divided into two groups： insulin and sitagliptin group,and insulin group. The levels of body mass index（ BMI）,fast blood glucose（ FBG）,2 hour postprandial blood glucose（ 2h PG）,Hb A1 c,maximum and minimum blood glucose difference（ ΔMMBG）,mean postprandial maximum blood glucose（ MPMG）,the amount of insulin and the frequency of hypoglycemia before and after the treatment of the two groups were observed. Results After 12 weeks treatment,the levels of FBG,2h PG and Hb A1 c significantly decreased（ P〈0. 05）. However,there was no significant difference between the two groups（ P〉0. 05）. Compared with insulin group,the levels of ΔMMBG and MPMG,and the amount of insulin significantly decreased in insulin and sitagliptin group after 12 weeks treatment（ P〈0. 05）,and there was statistical difference between the two groups（ P〈0. 05）. Before and after the treatment of insulin and sitagliptin group,BMI did not change significantly. However,BMI increased in insulin group compared with before treatment. After treatment,there was statistical significance in BMI between the two groups（ P〈0. 05）. Compared with insulin group,the frequency of hypoglycemia significantly reduced in insulin and sitagliptin group（ P〈0. 05）,and there was statistical difference between the two groups（ P〈0. 05）. Conclusion Sitagliptin combined with insulin could control the blood glucose of the patients who present with worse efficacy only with the treatment of large- dose insulin. And the treatment can decrease insulin dose without increasing the weight,and also can reduce fluctuations in blood glucose and hypoglycemia.