二甲双胍和格列吡嗪对新诊断2型糖尿病患者胰岛素分泌功能的影响

The effect of metformin and glipizide monotherapy on insulin secretion function in newly diagnosed type 2 diabetes

目的研究二甲双胍与格列吡嗪单药治疗对胰岛素分泌功能的影响。方法筛选2007~2012年门诊新诊断2型糖尿病患者160例,分为二甲双胍组（81例）和格列吡嗪组（79例）,分别采用二甲双胍和格列吡嗪单药治疗,分别观察两组治疗后血糖水平及胰岛素分泌指标的变化情况。结果两组用药后空腹血糖、餐后2 h血糖和糖化血红蛋白均较基线时明显降低（P均〈0.01）。二甲双胍组用药后HOMA-β%较基线时明显升高（P〈0.01）,而HOMA-IR和ΔPI均较基线时明显降低（P均〈0.01）;精氨酸刺激后各时点PI值用药后均较基线时明显降低（P〈0.01）。格列吡嗪组用药后HOMA-β%和ΔTI较基线时明显升高（P〈0.01）。结论二甲双胍与格列吡嗪单药治疗均能较好控制2型糖尿病患者的血糖水平。二甲双胍不仅减轻机体胰岛素抵抗程度,而且增加基础胰岛素分泌功能,提高胰岛素质量。格列吡嗪可改善基础胰岛素分泌及早相胰岛素分泌功能。

Objective To evaluate the effect of metformin and glipizide monotherapy on insulin secretion. Methods One hundred and sixty newly diagnosed type 2 diabetic patients who came to the outpatient department from 2007 to 2012 were divided into two groups named metformin group（n=81） and glipizide group（n=79）, which were treated with metformin and glipizide respectively. The variation of blood glucose levels and insulin secretion indexes after treatment were observed. Results Compared with baseline, fasting plasma glucose, 2 h postprandial plasma glucose and glycated hemoglobin were all significantly decreased after treatment in both groups（all P〈0.01）. After treatment with metformin,HOMA-β% was significantly increased compared with baseline（P〈0.01）, whereas HOMA-IR and the incremental value of serum proinsulin（ΔPI） were significantly decreased（all P〈0.01）. Proinsulin at different times after arginine stimulation were all significantly decreased compared with baseline（P〈0.01）. After treatment with glipizide, HOMA-β%and ΔPI were significantly increased compared with baseline（P〈0.01）. Conclusion Blood glucose level can be effectively controlled by both metformin and glipizide monotherapy. Metformin could not only reduce insulin resistance,but also improve basal insulin secretion and the quality of insulin at the same time. Glipizide could both improve basal insulin secretion and early-phase insulin secretion function.