不同降糖方案对初诊2型糖尿病患者胰高血糖素样肽-1的影响及与β细胞功能的相关性

Effects of different hypoglycemic treatments on glucagon-like peptide-1 and its correlation with β cells function in newly diagnosed type 2 diabetes mellitus

目的观察不同降糖方案对初诊2型糖尿病(T2DM)患者的胰高血糖素样肽-1(GLP-1)水平的影响及其与β细胞功能的相关性。方法将76例初诊T2DM患者随机分为诺和锐30组和口服药物组,治疗前后进行OGTT试验,测定0、30、120 min时血糖,检测GLP-1、C肽、胰岛素等指标,计算HOMA胰岛素分泌指数(HOMA-IS)及抵抗指数(HOMA-IR)。以健康者30例作为对照组,比较GLP-1水平,分析治疗前后各指标变化。结果不同降糖治疗方案的各时间点比较,血糖及其曲线下面积(AUCg)显著降低(P<0.05);胰岛素、C肽及其曲线下面积(AUCins、AUCc-p)显著升高(P<0.05);HOMA-IR显著降低(P<0.05),HOMA-IS、△INS30/G30、△INS120/G120显著升高(P<0.05)。与治疗前比较,诺和锐30组和口服药物组各时间点GLP-1水平及AUCglp(GLP-1曲线下面积)均显著升高(P<0.05),在120 min达峰值,接近对照组曲线。结论初诊T2DM患者GLP-1水平低于正常值。不同降糖治疗均使GLP-1升高。胰岛素、C肽及AUCins、AUCc-p、HOMA-IS、HOMA-IR等明显改善,提示β细胞功能恢复,胰岛素抵抗减轻。

ObjectiveTo observe different hypoglycemic treatments on glucagon like peptide 1（GLP 1） and its correlation with β cells function in newly diagnosed type 2 diabetes mellitus（T2DM）. MethodsA total of 76 patients with newly diagnosed T2DM were randomly divided into insulin aspart 30 group and oral drugs group. OGTT test were measured at 0, 30, 120 min, the serum levels of GLP 1 and corresponding C peptide, and insulin levels were measured, HOMA insulin secretion and insulin resistance index were calculated. Then 30 healthy cases were as the control group, GLP 1 levels were analyzed, and the changes of the index were compared. ResultsAt each time point, blood glucose and glucose area under the curve （AUCg） was significantly decreased （P〈0.05）. Insulin and C peptide and the AUC （AUCins, AUCc p）were increased （P〈0.05）. HOMA IR was statistically decreased compared with pre therapy（P〈0.05）, HOMA IS and △INS30/G30, △INS120/G120 were significantly increased （P〈0.05）. Compared with pre therapy, GLP 1 levels and AUCglp （area under the curve GLP 1） were significantly increased （P〈0.05）, and reached the peak at 120 min, closed to secretion curve of the control group. ConclusionGLP 1 levels were lower than normal in newly diagnosed T2DM patients, and different hypoglycemic drugs makes GLP 1 levels increase. Insulin, C peptide and AUCins, AUCc p, HOMA IS, HOMA IR, etc., suggest that β cell function is restored and insulin resistance is reduced.