西格列汀联合精蛋白锌重组人胰岛素治疗2型糖尿病的疗效观察

目的：观察西格列汀联合精蛋白锌重组人胰岛素治疗2型糖尿病的疗效。方法60例使用精蛋白锌重组人胰岛素混合注射液优泌林70/30治疗〉3个月，胰岛素总量〉30U/d，且糖化血红蛋白≥8.0%的2型糖尿病患者，随机分为观察组和对照组，观察组加用西格列汀片100mg，1次/d，对照组加用二甲双胍片0.5g，2次/d治疗，疗程均为12周，比较治疗前后空腹血糖（FPG）、餐后2h血糖（2hPG）、糖化血红蛋白（HbA1c）、胰岛素敏感性、胰岛素分泌指数（HOMA-β）、胰岛素抵抗指数（HOMA-IR）、每日胰岛素总量变化及低血糖发生情况。结果治疗12周后，观察组及对照组FPG、2hPG、HbA1c、HOMA-IR均有下降，HOMA-β升高，与对照组比较，观察组FPG[（6.8±0.8） mmol/L vs（7.1±0.5）mmol/L]、2hPG[（8.1±0.8）mmol/L VS（8.9±3.1）mmol/L]、HbA1c[（6.4±0.8）%vs（6.6±0.7）%]、HOMA-IR（2.6±0.6 vs 2.9±0.5）下降更显著（P〈0.05），HOMA-β升高优于对照组（5.8±0.4）vs（4.8±0.4），（P〈0.05）。对照组治疗前后每日胰岛素总量无明显变化，观察组在治疗后每日胰岛素总量明显减少[（28.3±2.6）vs（34.6±3.4），（P〈0.05）]，两组在低血糖发生频次上差异无统计学意义（P〉0.05）。结论对于胰岛素治疗血糖控制不佳的2型糖尿病患者，加用西格列汀治疗，可有效控制血糖，降低糖化血红蛋白，减少胰岛素使用剂量，并且不增加低血糖发生风险，西格列汀联合胰岛素治疗是一种安全有效的治疗方法。

ObjectiveTo observe the efficacy of Sitagliptin combined with insulin on type 2 diabetes mellitus.MethodsSixty patients were randomly divided into observation group and control group,all of them with the HbA1c higher than 8.0%,and received the treatment of mixed protamine zinc recombinant human insulin more than 30U per day for at least 3 months,the patients in observation group received 100mg Sitagliptin per day,and in control group received 500mg metformin 2 times a day,meantime,all the groups continue mixed protamine zinc recombinant human insulin . After 12 weeks,we detected and analyzed the levers of fast plasma glucose（FPG）,2 hour postprandial glucose（2hPG）,HbA1c,β-cell function index（HOMA-β）,insulin resistance index（HOMA-IR）,the dose of insulin and the incidences rate of hypoglycemia.Results the levers of FPG,2hPG,HbA1c,HOMA-IR,were decreased and HOMA-β was increased after treatment in 2 groups. Compared with control group, the levers of FPG（6.8±0.8mmol/L vs 7.1±0.5mmol/L）、2hPG（8.1±0.8mmol/L vs 8.9±3.1mmol/L）,HbA1c6.4±0.8% vs 6.6±0.7%）, HOMA-IR（2.6±0.6 vs. 2.9±0.5）were decreased more significantly in observation group（P〈0.05）,and the HOMA-β was better（5.8±0.4 vs 4.8±0.4P〈0.05）. the dosage of insulin in observation group was significantly decreased（28.3±2.6 vs 34.6±3.4P〈0.05）,and no serious of hypoglycemia was observed in 2 groups.ConclusionsSitagliptin can be given to the type 2 diabetes patients suffering from large dose of insulin without a satisfactory control of blood glucose.It can help these patients control sugar more effectively,reduce HbA1c,decrease insulin doses,and do not increase the risk of hypoglycemia,making the treatment of Sitagliptin combined with insulin a safe and effective method.