首发2型糖尿病患者采用甘精胰岛素联合格列美脲治疗对其胰岛β细胞功能及血糖的影响

Effect of Insulin Glargine Combined with Glimepiride on Islet β-cell Function and Blood Glucose in Patients with First-episode Type 2 Diabetes

目的探讨首发2型糖尿病患者采用甘精胰岛素联合格列美脲治疗疗效。方法选取上海市南京东路街道社区卫生服务中心2017年1月—2018年1月收治的150例首发2型糖尿病患者,在患者同意情况下,按照治疗方法不同分为对照组与观察组,每组各75例。对照组采用甘精胰岛素联合吡格列酮片治疗;观察组采用甘精胰岛素联合格列美脲治疗。比较两组患者治疗前后体质量指数、空腹下血糖水平、餐后2 h血糖水平、糖化血红蛋白、空腹C肽及餐后2 hC肽水平;计算两组治疗前后胰岛素功能指数与胰岛素抵抗指数;记录两组治疗期间不良反应。结果两组患者治疗3个月后FPG、2 hPG、HbA1c和HOMA-IR较治疗前显著下降,而FC-P、2 hC-P和HOMA-islet明显高于治疗前,差异有统计学意义(P<0.05);组间比较,P>0.05。观察组治疗3个月后BMI为(25.17±1.29)kg/m^2明显低于对照组(27.58±1.69)kg/m^2,t=9.816,P=0.000;观察组治疗前后BIM相比较,P>0.05,对照组明显高于治疗前,P<0.05。观察组胰岛素剂量为(18.65±1.23)U/d,明显低于对照组(20.63±1.98)U/d,t=7.356,P=0.000;观察组血糖水平达标时间平均为(12.15±0.75)d,明显短于对照组(13.88±1.19)d,t=10.651,P=0.000。观察组低血糖发生率为1.33%(1/75),明显低于对照组9.33%(7/75),χ~2=4.753,P=0.029。结论首发2型糖尿病患者采用甘精胰岛素联合格列美脲与甘精胰岛素联合吡格列酮均可显著控制患者血糖水平,但前者可明显降低患者低血糖发生率,且体重变化更小,因此值得推荐。

OBJECTIVE To investigate the efficacy of insulin glargine combined with glimepiride in patients with first-episode type 2 diabetes. METHODS 150 patients with first-episode type 2 diabetes admitted from January 2017 to January 2018 in the hospital were grouped into control group and observation group according to different treatment methods, with 75 cases in each group. The control group was treated with insulin glargine and pioglitazone tablets; the observation group was treated with glargine combined with glimepiride. The body mass index, fasting glucose level, postprandial blood glucose level,glycosylated hemoglobin, fasting C-peptide and postprandial 2 were compared before and after treatment in the two groups. hC peptide levels; HOMA-islet and HOMA-IR were calculated before and after treatment in both groups; Adverse reactions during treatment were recorded. RESULTS After 3 months oftreatment, FPG, 2 hPG, HbA1c, and HOMA-IR were significantly decreased in the two groups after treatment, while FC-P, 2 hC-P,and HOMA-islet were significantly higher than before treatment, and the difference was statistically significant（P〈0.05）; between groups, P〈0.05. The BMI was（25.17±1.29）kg/m^2 in the observation group after 3 months of treatment was significantly lower than the control group（27.58±1.69）kg/m^2, t=9.816, P=0.000; BIM in the observation group before and after treatment was compared（P〉0.05）.The control group was significantly higher than before treatment, P〈0.05. The insulin dose in the observation group was（18.65±1.23）U/d, which was significantly lower than that in the control group（20.63±1.98） U/d, t=7.356, P=0.000; the average time for the blood glucose level in the observation group was（12.15±0.75）d Significantly shorter than the control group（13.88±1.19）d, t=10.651, P=0.000. The incidence of hypoglycemia in the observation group was 1.33%（1/75）, which was significantly lower than the control group 9.33%（7/75）, χ^2=4.753, P=0.029. CONCLUSION Use of insulin glargine combined with glargine and insulin glargine combined with pioglitazone in patients with first-episode type 2 diabetes could significantly control the blood glucose level, but the former could significantly reduce the incidence of hypoglycemia in patients with less weight change, which was worth recommending.