DPP-4抑制剂对胰岛素治疗2型糖尿病患者血糖波动的影响

Effect of DPP-4 inhibitor on glucose fluctuation in patients with type 2 diabetes mellitus treated by insulin

目的探讨西格列汀对门冬胰岛素30控制不佳的2型糖尿病(T2DM)患者血糖波动性的影响。方法选择广东医科大学附属中山医院2014年1月1日至2014年12月31日门冬胰岛素30控制不佳的2型糖尿病患者90例,随机分为三组:单纯持续皮下胰岛素注射治疗组(CSII组),阿卡波糖联合CSII组(CSII+Aca组),西格列汀联合CSII组(CSII+Sig组)。每组各30例,强化治疗2周,最后3d行72h动态血糖监测(CGMS),观察24h内平均血糖(24h MBG)、最大血糖波动幅度(LAGE)、1日内平均血糖波动幅度(MAGE)、餐后血糖尖峰值(PGS)、餐后血糖达峰时间(△t)、餐后血糖漂移幅度(PPGE),餐后血糖漂移时间(T总)。治疗结束时比较胰岛素用量之差(△胰岛素)、低血糖发生率、血糖达标率、血糖谱。结果治疗2周后,CSII+Sig组和CSII+Aca组的日内血糖波动指标(24h MBG、LAGE及MAGE)及餐后血糖波动指标(PGS、△t、PPGE、T总)均显著低于CSII组(P<0.05);而CSII+Sig组与CSII+Aca组之间血糖波动指标的差异无统计学意义(P>0.05)。治疗后比较3组△胰岛素、低血糖发生率、血糖达标率,CSII+Sig组均偏低(P<0.05)。结论短期CSII治疗联合应用西格列汀,其降糖效果不低于联合应用阿卡波糖,能平稳降糖,减轻该类患者全天血糖波动,有效减少△胰岛素,低血糖发生率更低。

Objective To probe into the effect of sitagliptin on blood glucose fluctuation of the patients with type 2 diabetes mellitus（T2DM） and poor control by insulin aspart 30. Methods Ninety cases of T2DM and poor control by insulin aspart 30 in af- filiated Zhongshan hospital from January 1,2014 to December 31,2014 were selected and randomly divided into three groups：simply continuous subcutaneous insulin injection（CSII）,acarbose combined CSII group（CSII ＋ Aea） and sitagliptincombined CSII group （CSII ＋ Sig） ,30 cases in each group. Three groups received the intensive treatment for 2 weeks,and72-h continuous glucose monitoring was performed on last 3 d. The 24 h mean blood glucose（24 hMBG） ,largest amplitude of glyeemic fluctuation（LAGE）,mean amplitude of glycemic excursion（MAGE） within 1 d,postprandial blood glucose spike（PGS）,postprandial glucose peak time（~t）, postprandial glucose excursion（PPGE） and total T were observed within 24 h. The difference of insulin dose（A insulin） ,hypogly- cemia incidence, glucose-target rate, blood glucose profiles were compared at the end of treatment. Results After two-week treat- ment,intraday blood glucose variation indicators（24 hMBG,LAGE and MAGE） and postprandial blood glucose variation indicators （PGS,△t,PPGE and total T） in the CSII＋Sig and CSII＋Aca groups were significantly lower than those in the CSII group（P〈 0.05）, while the differences in blood glucose variation indicators between the CSII＋Sig group and CSII＋ Aca group were not sta- tistical significant（P〉0.05）. In the comparison after treatment, A insulin, hypoglycemia incidence and glucose-target rate in the CSI ＋ Sig group were lower（P〈0.05）. Conclusion The combined application of short-term CSII and sitagliptin will achieve a better effect than the combitxatiott with acarhose,can smoothly and steadily reduces the blood gkmose level,reLieves the whole day glucose fluctuations,effectively reduces △ insulin,and has lower hypoglycemia occurrence rate.