地特胰岛素联合利拉鲁肽治疗肥胖2型糖尿病患者的效果分析

Therapeutic effect of insulin detemir combined with liraglutide on obese type 2 diabetes

目的分析地特胰岛素联合利拉鲁肽治疗肥胖2型糖尿病患者的效果。方法选取 2011年 11月至2012年9月在解放军第三0五医院住院治疗的32例肥胖2型糖尿病患者，均给予地特胰岛素联合利拉鲁肽连续治疗24周。于治疗前及治疗12、24周后检测糖化血红蛋白、空腹血糖、餐后2 h血糖、总胆固醇、三酰甘油、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇以及体质量。治疗开始后每2周测血糖及体质量并观察其变化趋势。记录低血糖、胃肠道反应等不良反应发生情况。结果治疗期间共有3例脱落，1例为出现严重胃肠道反应，1例为频发低血糖，1例因个人原因退出观察。完成治疗的29例患者中，12例发生低血糖，17例发生胃肠道反应。治疗12、24周后，29例患者空腹血糖、餐后2 h血糖、糖化血红蛋白、总胆固醇、三酰甘油、LDL-C以及体质量均明显低于治疗前［（7.1±1.1）、（6.8±1.2）mmol/L比（10.4±3.6）mmol/L，（9.5±1.9）、（8.2±2.0）mmol/L比（16.6±4.4）mmol/L，（7.5±0.7）、（7.2±0.6）%比（10.3±0.8）%，（4.5±0.9）、（4.4±0.7）mmol/L比（5.3±1.0）mmol/L，（1.8±0.8）、（1.8±0.6）mmol/L比（2.1±0.9）mmol/L，（3.1±0.9）、（3.1±1.3）mmol/L比（3.6±1.1）mmol/L，（94.4±4.2）、（91.2±2.0）kg比（103.2±5.9）kg］（均P＜0.05），且体质量在治疗24周后明显低于治疗12周后（P＜0.05）。随着治疗时间的延长，空腹血糖、餐后2 h血糖、体质量逐渐下降；8周后血糖趋于平稳，而体质量则在20周后不再有明显变化。结论地特胰岛素联合利拉鲁肽治疗肥胖2型糖尿病患者效果确切，同时能够有效降低体质量。

ObjectiveTo analyze the therapeutic effect of insulin detemir combined with liraglutide on obese type 2 diabetes. MethodsThirty-two obese patients with type 2 diabetes were enrolled in the 305 Hospital of People′s Liberation Army from November 2011 to September 2012. The patients were treated with insulin detemir and liraglutide for 24 weeks. Glycosylated hemoglobin（HbA1c）, fasting plasma glucose（FPG）, postprandial 2 h plasma glucose（2hPG）, total cholesterol（TC）, triacylglycerol（TG）, low density lipoprotein cholesterol（LDL-C）, high density lipoprotein cholesterol and body mass were examined after 12, 24 weeks of treatment. Blood glucose and body mass were examined every 2 weeks during treatment. Adverse reactions were recorded. ResultsThree cases withdrew from the observation（1 case had severe gastrointestinal reaction, 1 case had frequent hypoglycemia, 1 case had personal reasons）. In 29 cases, hypoglycemia occurred in 12 cases and gastrointestinal reaction occurred in 17 cases. FPG, 2hPG, HbA1c, TC, TG, LDL-C and body mass after 12, 24 weeks of treatment were significantly lower than those before treatment[（7.1±1.1）,（6.8±1.2）mmol/L vs （10.4±3.6）mmol/L; （9.5±1.9）,（8.2±2.0）mmol/L vs （16.6±4.4）mmol/L; （7.5±0.7）,（7.2±0.6）% vs （10.3±0.8）%; （4.5±0.9）,（4.4±0.7）mmol/L vs （5.3±1.0）mmol/L; （1.8±0.8）,（1.8±0.6）mmol/L vs （2.1±0.9）mmol/L; （3.1±0.9）,（3.1±1.3）mmol/L vs （3.6±1.1）mmol/L; （94.4±4.2）,（91.2±2.0）kg vs （103.2±5.9）kg]（P〈0.05）; body mass after 24 weeks of treatment was significantly lower than that after 12 weeks of treatment（P〈0.05）. FPG, 2hPG and body mass gradually decreased during treatment; FPG and 2hPG levels were stable after 8 weeks; body mass was stable after 20 weeks. ConclusionsThe treatment of insulin detemir in combination with liraglutide has obvious curative effect and weight-sparing effect on obese type 2 diabetes.