加用格列美脲对单用预混胰岛素治疗2型糖尿病患者血糖漂移的影响

The effect of additional glimepiride compared with single use of premixed insulin on glucose excursion in type Ⅱ diabetic patients

目的观察继往单用预混胰岛素治疗血糖控制不佳的2型糖尿病患者加用格列美脲后对血糖漂移的影响及其安全性。方法将64例单用预混胰岛素治疗大于3个月,血糖控制不佳的T2DM患者,随机将其分为治疗组(33例,A组)和对照组(31例,B组),A组患者在调整预混胰岛素剂量的同时,予中餐前口服格列美脲(联合治疗14 d),B组患者维持原治疗方案,继续调整胰岛素剂量,采用动态血糖监测的方法,比较治疗前后血糖漂移、胰岛素的剂量的变化及低血糖发生情况。结果经治疗后2组患者的24 h平均血糖、FBG、2 h PG较治疗前均显著下降(P<0.05),A组患者的3指标分别由治疗前的(11.73±3.91)mmol/L、(10.2±2.1)mmol/L、(16.9±2.3)mmol/L降至(7.42±1.82)mmol/L,(5.8±2.4)mmol/L、(9.6±1.9)mmol/L。B组患者3种指标则由治疗前的(11.36±2.05)mmol/L、(9.9±2.6)mmol/L、(17.1±1.8)mmol/L降至(8.07±3.43)mmol/L、(6.2±2.8)mmol/L、(10.2±0.8)mmol/L,A组下降更为明显(P<0.05)。血糖漂移与胰岛素剂量2组患者治疗后呈不同结果,A组血糖漂移由(6.87±3.91)mmol/L降至(3.28±1.14)mmol/L(P<0.05),胰岛素剂量由(45±12)IU降至(36±10)IU(P<0.05),B组患者的血糖漂移(6.54±2.66)mmol/L增加至(7.64±3.82)mmol/L(P<0.05)和胰岛素剂量(44±15)IU增加至(62±9)IU(P<0.05)。A组低血糖发生率降低50%,B组低血糖发生率增加9.68%。结论对单用预混胰岛素控制不佳的T2DM患者,加用格列美脲治疗能有效地降低患者的血糖漂移及减少胰岛素用量,显著降低低血糖的发生。

Objective To observe the effect and safety of additional glimepiride on glucose excursion in type 2 diabetic patients with poor blood glucose control when previously treated by single use of premixed insulin. Methods 64 T2 DM patients with poor blood glucose control after single treatment of premixed insulin over three months were randomly divided into the treatment group（33 patients,Group A） and the control group（31 patients,Group B）.Patients in group A was treated by additional glimepiride（combined treatment for 14 d） before lunch as well as adjusted premixed insulin dose.And patients in group B was treated by previous therapy with adjusted insulin dose.According to the results of continuous glucose monitoring,the glucose excursion,change of insulin dose and incidence of hypoglycemia before and after treatment were compared. Results The 24 h average blood glucose,FBG,and 2 h PG of patients in two groups after treatment were significantly reduced when compared with those before treatment（P〈0.05）.In group A,the 24 h average blood glucose,FBG,and 2 h PG were（11.73±3.91）mmol/L,（10.2 ±2.1）mmol/L,and（16.9 ±2.3）mmol/L before treatment,and reduced to（7.42±1.82）mmol/L,（5.8±2.4）mmol/L,and（9.6±1.9）mmol/L after treatment.In group B,the 24 h average blood glucose,FBG,and 2 h PG were（11.36±2.05）mmol/L,（9.9±2.6）mmol/L,and（17.1±1.8）mmol/L before treatment,and reduced to（8.07±3.43）mmol/L,（6.2±2.8）mmol/L,（10.2±0.8）mmol/L after treatment.The reductions of these threeindicators were more significant in group A than in group B（P〈0.05）. The results of glucose excursion and change of insulin dose were different in two groups.In group A,the glucose excursion was（6.87 ±3.91）mmol/L before treatment,and reduced to（3.28 ±1.14）mmol/L after treatment（P〈0.05）;the insulin dosewas（45±12）IU before treatment, and reduced to（36±10）IU（P〈0.05）.In group B,the glucose excursion was（6.54±2.66）mmol/L before treatment, and increased to（7.64±3.82）mmol/L after treatment（P〈0.05）; the insulin dose was（44±15）IU before treatment, and increased to（62±9）IU after treatment（P〈0.05）.The incidence of hypoglycemia in group A reduced50%,while the incidence increased by 9.68 % in group B.Conclusion Additional glimepiride can reduce the glucose excursion and insulin dose in type 2 diabetic patients with poor blood glucose control by single use of premixed insulin,and can also significantly reduce the incidence of hypoglycemia.