二甲双胍联合维格列汀治疗初诊2型糖尿病的疗效及对血糖波动的影响

Study on the efficacy of combination therapy of vildagliptin and metformin in treatment of patients with type 2 diabetes mellitus and its influence on blood glucose fluctuation

目的探讨二甲双胍联合维格列汀治疗初诊2型糖尿病(T2DM)的疗效及对血糖波动的影响。方法将64例初诊T2DM患者随机分为两组,分别采用二甲双胍+格列美脲(格列美脲组,32例)和二甲双胍+维格列汀(维格列汀组,32例),疗程均为12个月。比较两组患者血糖、血糖波动及不良反应情况。结果治疗后,两组的空腹血糖(FPG)、餐后2 h血糖(2 h PG)及糖化血红蛋白(Hb A1c)水平均明显下降,而维格列汀组2 h PG、Hb A1c水平显著低于格列美脲组(P<0.05);治疗后,两组胰高血糖素样肽-1(GLP-1)明显升高,胰岛素(INS)水平明显下降,而维格列汀组上述指标的改善更为显著(P<0.05);与格列美脲组比较,维格列汀组血糖达标时间明显缩短,24 h平均血糖(MBG)、平均血糖波动幅度(MAGE)均显著降低(P<0.05);两组低血糖事件、腹部不适的发生率无显著性差异(P>0.05)。结论与二甲双胍联合格列美脲相比,二甲双胍联合维格列汀治疗初诊T2DM患者具有更好降糖效果,可保护胰岛β细胞,且血糖波动小。

Objective To explore the efficacy of combination therapy of vildagliptin and metformin in treatment of patients with newly di-agnosed type 2 diabetes mellitus（T2DM）and its influence on the fluctuation of blood glucose. Methods A total of 64 cases of newly diagnosed T2DM were randomly divided into two groups,patients in glimepride group（n = 32 cases）were given with metformin plus glimepiride and patients in vildagliptin group（n = 32 cases）were treated with vildagliptin plus metformin. The treatment course in patients of these 2 groups was 12 months. The change in blood level of glucose,the fluctuation of blood glucose and the occurrence of adverse events were compared and analyzed between these two groups. Results After treatment,the blood levels of FPG,2 hPG,and HbA1c in patients of both groups were reduced,the levels of 2h PG and HbA1c in patients of vildagliptin group were significantly lower than those of patients in glimepiride group（ P 〈 0. 05）. After treatment,the blood level of GLP^-1 was increased,the level of insulin（INS）was reduced,and above indicators in patients of vildagliptin group were significantly improved than those of patients in glimepiride group（ P 〈 0. 05）. In comparison with glimepiride group,the therapeutic period for achievement of the goal was shortened,and the MBG and MAGE in patients of vildagliptin group were significantly reduced（ P 〈 0. 05）. There was no significant difference in incidence rates of hypoglycemia and abdominal discomfort（ P 〉 0. 05）. Conclusion In comparison with combination therapy of metformin and glimepiride,the comnination therapy with vildagliptin and metformin in treatment of patients with newly diag-nosed T2DM has better hypoglycemic effect,it can protect pancreatic β cells,and it can lower the fluctuation of blood glucose.