利格列汀联合地特胰岛素治疗老年2型糖尿病的临床观察

Clinical observation of linagliptin combined with insulin detemir for elderly patients with type 2 diabetes

目的观察使用2种以上口服降糖药物血糖控制不佳的老年2型糖尿病(T2DM)患者,换用利格列汀联合地特胰岛素的疗效和安全性。方法将2015年1月至2016年10月湖北省中西医结合医院收治的64例使用2种以上口服降糖药血糖控制不佳的老年T2DM患者分为治疗组和对照组,各32例。治疗组使用利格列汀联合地特胰岛素,对照组单用门冬胰岛素30,2组均治疗12周。观察比较2组患者治疗前后血糖控制情况、胰岛素抵抗指数(HOMA-IR)、体重指数(BMI)、日均胰岛素用量及2组不良反应的发生情况。结果 2组空腹血糖(FBG)、餐后2小时血糖(2h PG)和糖化血红蛋白(HbA1c)均较治疗前明显降低,且治疗组FBG下降幅度大于对照组,HOMA-IR的改善情况优于对照组,差异均有统计学意义(P<0.05);2组2h PG及HbA1c下降幅度无明显差异,差异无统计学意义(P>0.05)。治疗组治疗后BMI较治疗前无改变,差异无统计学意义(P>0.05),而对照组治疗后BMI增加,差异有统计学意义(P<0.05)。治疗组日均胰岛素用量少于对照组,低血糖及不良反应总发生率低于对照组,差异均有统计学意义(P<0.05)。结论使用2种以上口服降糖药血糖控制不佳的老年T2DM患者换用利格列汀联合地特胰岛素或单用门冬胰岛素30均能有效控制血糖,但前种方案日均胰岛素用量少,低血糖反应发生率低,安全性更高,更适合老年T2DM患者。

Objective To assess the efficacy and safety of linagliptin combined with insulin detemir in the elderly type2diabetes mellitus(T2DM)patients with inadequate glycemic control by two or more kinds of oral hypoglycemic drugs.Methods Totally64elderly T2DM patients with inadequately control by two or more kinds of oral hypoglycemic drugs from January2015to October2016in Hubei Provincial Hospital of Integrated Chinese and Western Medicine were randomly divided into treatment group and control group,with32cases in each group.The treatment group was treated by linagliptin combined with insulin detemir,the control group was treated by insulin aspart30injection alone.The blood glucose control,homeostatic model assessment of insulin resistance index(HOMA?IR),body mass index(BMI),daily insulin dosage and incidence of adverse reactions were assessed before and after the treatment for12weeks.Results After the12?week treatment,the level of fasting blood?glucose(FBG),2?hour post?meal blood glucose(2hPG)and glyeosylated hemoglobin(HbA1c)in both groups were significantly decreased,the differences were statistically significant(P<0.05).Compared with the control group,the level of FBG was lower,HOMA?IR were better,the differences were statistically significant(P<0.05).While the level of2hPG and HbA1c were not different significantly in two groups(P>0.05).The BMI was increased in control group(P<0.05),and showed no change in the treatment group(P>0.05).The daily insulin dosage,incidence of hypoylycemia and adverse reactions in the treatment group were lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion For the elderly T2DM patients with inadequate glycemic control by two or more kinds of oral hypoglycemic drugs,the combination of linagliptin with insulin detemir or insulin aspart30injection alone are good chooses.Compared with insulin aspart30injection alone,linagliptin combined with insulin detemir can significantly decrease daily insulin dosage and has lower the incidence of hypoglycemia,is more suitable for the elder patients.