伏格列波糖加维格列汀方案辅助胰岛素治疗磺脲类药物无效的2型糖尿病

Clinical study of voglibose combined with vildagliptin in treatment of patients with sulfonylurea invalid type 2 diabetes mellitus

目的 :探讨伏格列波糖联合维格列汀辅助胰岛素治疗对磺脲类药物无效的2型糖尿病患者动态血糖水平的影响及不良反应。方法:研究对象选取2015年4月至2017年4月我院收治的磺脲类药物无效的2型糖尿病患者共100例,以随机抽签法分为对照组(50例)和观察组(50例),分别给予维格列汀单用(对照组)和维格列汀与伏格列波糖联用(观察组)治疗;比较2组患者治疗前后24 h平均血糖、24 h平均血糖标准差、平均血糖波动幅度(mean amplitude of glycemic excursions,MAGE)、早餐后2 h血糖、晚餐后2 h血糖,糖化血红蛋白(glycated hemoglobin A1c,Hb A1c),用药后不同时间点血糖、胰高血糖素样肽-1(glucagon-like peptide-1,GLP-1)水平及不良反应发生率。结果:观察组患者治疗后24 h平均血糖、24 h平均血糖标准差、MAGE、早餐后2 h血糖、晚餐后2 h血糖及Hb A1c水平均显著优于对照组及其治疗前(P<0.05);2组患者治疗后不同时间点血糖和GLP-1水平均显著高于治疗前(P<0.05);观察组患者治疗后30、60、120及180 min血糖水平均显著低于对照组(P<0.05);但观察组患者治疗后30、60、120及180 min GLP-1水平均显著高于对照组(P<0.05);2组患者不良反应发生率差异无统计学意义(P>0.05)。结论 :二联口服降糖方案辅助胰岛素治疗对磺脲类药物无效2型糖尿病可有效调节动态血糖水平,改善血糖和GLP-1指标,并未增加药物不良反应。

Objective To investigate the effect of voglibose combined with vildagliptin on levels of dynamic blood glucose and adverse reactions in patients with sulfonylurea invalid type 2 diabetes mellitus. Methods One hundred patients with type 2 sulfonylurea invalid diabetes mellitus from April 2015 to April 2017 in our hospital were randomly divided into control group（50 patients） and observation group（50 patients）, the control group was treated with vildagliptin alone and the observation group was treated with voglibose combined with vildagliptin. The levels of 24 h average blood sugar, 24 h average blood glucose standard deviation, mean amplitude of glycemic excursions（MAGE）, blood sugar 2 h after breakfast and blood sugar 2 h after dinner before and after treatment, levels of glycated hemoglobin A1 c（HbA1c）,blood glucose and glucagon-like peptide-1（GLP-1） at different time points after medication, and incidence of adverse effects of both groups were compared. Results The levels of 24 h average blood sugar, 24 h average blood glucose standard deviation, MAGE, blood sugar 2 h after breakfast, blood sugar 2 h after dinner and HbA1cafter treatment in observation group were significantly better than that in control group and that before treatment（P〈0.05）. The levels of blood glucose in 30, 60, 120 and 180 min after medication in observation group were significantly lower than that before medication（P〈0.05）. The levels of GLP-1 in 30, 60, 120 and 180 min after medication in observation group were significantly higher than that before medication（P〈0.05）. There was no significant difference in incidence of adverse effects between the two groups（P〉0.05）. Conclusions The combined oral glucose controlling agents program for treatment of sulfonylurea invalid type 2 diabetes mellitus can effectively regulate the dynamic blood glucose levels, improve the blood glucose and GLP-1 and does not increase the risk of adverse reactions.