糖尿病患者起始胰岛素治疗方案的选择及安全性评价

The choice of initial insulin treatment plan for patients with diabetes mellitus inadequately controlled with oral antidiabetic drugs

目的探讨口服二甲双胍控糖效果不佳糖尿病患者起始胰岛素治疗方案的选择及安全性。方法选取口服二甲双胍控糖效果不佳的2型糖尿病患者126例随机分为3组,在二甲双胍治疗基础上,分别联用西格列汀、起始剂量10U/d胰岛素、起始剂量15U/d胰岛素分别作为A组、B组、C组,治疗期间均根据血糖控制情况调整用药剂量,达到并维持空腹血糖≤5.6mmol/L。记录3组血糖达标率、达标时间、低血糖反应;计算治疗前后体重指数(BMI)、体重差值,统计三组治疗前后空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋(HbA1c)、胰岛素抵抗指数(HOMA-IR)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)。结果本研究中A组5例脱落,B组7例脱落,C组8例脱落。3组患者血糖达标率、低血糖反应发生率比较差异无统计学意义(P>0.05);C组血糖达标时间短于A组、B组(P<0.05),但A组、B组比较差异无统计学意义(P>0.05)。3组治疗后FPG、2hPG、HbA1c、HOMA-IR均下降,FINS上升,同组治疗前后差异有统计学意义(P<0.05),但3组组间比较差异无统计学意义(P>0.05)。A组治疗前后BMI、体重差值低于B组、C组,差异有统计学意义(P<0.05),但B组、C组比较差异无统计学意义(P>0.05)。结论口服二甲双胍控糖效果不佳2型糖尿病患者联合西格列汀、甘精胰岛素均可获得理想的降糖效果,且加大基础甘精胰岛素方案起始用药剂量可缩短血糖达标时间,但西格列汀在控制体重上更具优势。

Objective To investigate the initial insulin treatment plan for patients with diabetes mellitus inade- quately controlled with oral antidiabetic drugs and analyze its safety. Methods 126 patients with diabetes mellitus inade- quately controlled with metformin were randomized into group A, group B and group C. On the basis of treatment with metformin, group A were treated with sitagliptin, group B with starting dose 10 U/d of insulin and group C with 15 U/ d of insulin. According to the blood glucose control during treatment, the dose was adjusted to maintain the fasting blood glucose ≤ 5.6 mmol/L. The control rates of blood glucose, standard time and incidence of hypoglycemia in the three groups were recorded. The body mass index （BMI） and body weight difference were calculated. The fasting plasma glu- cose （FPG）, postprandial 2h plasma glucose （2hPG）, glycosylated hemoglobin （HbAlc）, insulin resistance index （HO- MA-IR）, triglyceride （TG） and low density lipoprotein cholesterol （LDL-C） in the three groups were statistically ana- lyzed before and after treatment. Results There were 5 cases in group A, 7 cases in group B and 8 cases in group C lost to follow up. There was no significant difference in the control rate of blood glucose and incidence of hypoglycemia among the three groups （P 〉 0.05）. The standard time of group C was shorter than that of group A and group B （P 〈 0.05） but there was no significant difference between group A and group B （P 〉 0.05）. After treatment, FPG, 2hPG, HbAlc and HOMA-IR decreased in the three group while FINS increased （P 〈 0.05） but there was no significant difference be- tween groups （P 〉 0.05）. BMI and body weight difference of group A were lower than those of group B and group C （P〈 0.05） but there was no significant difference between group B and group C （P 〉 0.05）. Conclusion The hypoglyce mic effects of sitagliptin and insulin glargine are good in patients with diabetes mellitus inadequately controlled with met formin. High starting dose of insulin glargine can shorten the standard time of blood glucose but sitagliptin has more ad vantages in controlling weight.