西格列汀对老年2型糖尿病轻度认知障碍患者血糖漂移和认知功能的影响研究

Effect of Sitagliptin on Glycemic Excursion and Cognitive Function among Elderly Type 2 Diabetic Patients with Mild Cognitive Impairment

目的研究西格列汀对老年2型糖尿病(T2DM)轻度认知障碍(MCI)患者血糖漂移及认知功能的影响。方法选择老年T2DM轻度认知障碍患者78例,随机分为研究组39例(西格列汀+二甲双胍组)和对照组39例(格列齐特+二甲双胍组)。两组患者联合用药前及用药24周后测量体质指数(BMI)、空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA_(1c))。所有患者治疗前后均接受72 h动态血糖监测(CGMS),根据监测结果计算日内平均血糖漂移幅度(MAGE)、日间血糖漂移幅度(MODD)、血糖水平标准差(SDBG)、平均餐后血糖漂移幅度(MPPGE),治疗前后用蒙特利尔认知评估量表(MoCA)评估认知功能。观察治疗前及药物治疗6个月后血糖、血糖漂移、认知功能的变化。结果治疗前,两组BMI、FBG、2hPG、HbA_(1c)、MAGE、MODD、SDBG、MPPGE、MoCA评分差异无统计学意义(P>0.05)。治疗后,研究组MAGE、MODD、SDBG、MPPGE低于对照组,MoCA评分高于对照组,差异有统计学意义(P<0.05);两组BMI、FBG、2 hPG、HbA_(1c)差异无统计学意义(P>0.05)。结论西格列汀可能通过降低老年T2DM轻度认知障碍患者的血糖漂移进而改善其认知功能。

Objective To explore the clinical effect of sitagliptin on glycemic excursion and cognitive function among elderly patients with type 2 diabetes mellitus(T2DM)and mild cognitive impairment.Methods Seventy-eight elderly T2DM patients with mild cognitive impairment were equally randomized into treatment group and control group,receiving 24-week treatment with metformin combined with sitagliptin,metformin combined with gliclazide,respectively.BMI,fasting blood glucose(FG),2-hour postprandial blood glucose(2 hPG),and glycosylated hemoglobin(HbA1c)were measured at baseline and at the end of the 24th week of treatment.Blood glucose level was monitored over a 3-day period with continuous glucose monitoring system(CGMS)before and after treatment,and according to the monitored results,the mean amplitude of glycemic excursions(MAGE),mean of daily differences(MODD),standard deviations of blood glucose(SDBG),mean postprandial glycemic excursion(MPPGE)were calculated.Cognitive function was evaluated with Montreal Cognitive Assessment(MoCA)before and after treatment.Parameters of blood glucose,glycemic excursions and cognitive functions before and after treatment were compared.Results The mean BMI,FBG,2 hPG,and HbA1c,MAGE,MODD,SDBG,MPPGE,and mean MoCA core were similar in both groups at baseline(P>0.05).After 6 months of treatment,although mean BMI,FBG,2 hPG and HbA1c were still similar in both groups(P>0.05),MAGE,MODD,SDBG,and MPPGE were much lower and mean MoCA score was much higher in the treatment group compared with the control group(P<0.05).Conclusion Sitagliptin may improve the cognitive function by reducing glycemic excursions in elderly T2DM patients with mild cognitive impairment.