新诊断2型糖尿病患者药物方案选择的预测因子探讨

Predictors of Drug Regimen Selection in Newly Diagnosed Type 2 Diabetic Patients

目的探索新诊断2型糖尿病患者药物方案选择的预测因子。方法选取2015年8月—2016年6月在北京大学人民医院内分泌科门诊就诊的新诊断糖化血红蛋白9%的2型糖尿病患者40例,收集患者一般情况、降糖药物应用及实验室检查等指标,随访3个月,分析血糖控制达标情况,了解糖化血红蛋白水平在首诊2型糖尿病患者中的治疗方案选择上的应用价值。进一步探讨针对2型糖尿病治疗方案选择的其他可能的预测因子。结果 (1)40例患者首次就诊降糖药物应用二甲双胍82.5%,磺脲类32.5%,胰岛素12.5%,阿卡波糖7.5%,单药治疗70.0%,双药联合25.0%,随访3个月后二甲双胍87.5%,磺脲类32.5%,胰岛素0.0%,阿卡波糖12.5%,单药治疗67.5%,双药联合治疗30.0%;(2)3个月后,单药治疗组与联合治疗组患者HbA1c达标者分别为81.5%和50.0%,两组HbA1c达标率差异无统计学意义;单药达标与联合治疗未达标组相比,空腹胰岛素水平偏低(P=0.07)。结论糖化血红蛋白水平选择药物在首诊2型糖尿病患者中有一定应用价值,但应注重糖尿病患者的个体化治疗,基线空腹胰岛素可能是预测患者药物治疗反应的预测因子。

Objective This paper tries to explore predictors of choice of drug regimen for newly diagnosed type 2 diabetic patients.Methods 40 cases of type 2 diabetes patients from August 2015 to June 2016 in this hospital for clinic diagnosis of glycated hemoglobin 9%,collecting the general situation of patients,hypoglycemic agents and laboratory tests and other indicators,followed up for 3 months,analysis of glycemic control standards was conducted to understand the level of glycosylated hemoglobin in the first diagnosis of type 2 diabetes patients treatment options on the value.Further to explore other possible predictors of treatment options for type 2 diabetes.Results①Metformin 82.5%,sulfonylureas 32.5%,insulin 12.5%,acarbose 7.5%,monotherapy 70.0%and combination of two drugs 25.0%after 3 months of follow-up in 40 patients.Metformin 87.5%,sulfonylureas 32.5%,insulin 0.0%,acarbose 12.5%,monotherapy 67.5%,double-drug combination therapy 30.0%.②3 months later,the monotherapy group and the combination therapy group HbA1c compliance were 81.5%and 50.0%respectively,and there was no significant difference between the two groups in HbA1c compliance rate.The fasting insulin level was lower in the single-drug standard than in the non-compliance group(P=0.07).Conclusion HbA1c levels may be of value in newly diagnostic patients with type 2 diabetes,but individualized treatment should be emphasized in patients with diabetes.Baseline fasting insulin may be a predictor of predictors of drug-response in patients.