吡格列酮和二甲双胍对初诊2型糖尿病患者改善胰岛素抵抗的效果比较

Effect comparison of pioglitazone and metformin on improving insulin resistance in newly diagnosed type 2 diabetic patients

目的比较吡格列酮和二甲双胍治疗2型糖尿病(T2DM)患者对改善胰岛素抵抗及生活质量的影响。方法收集医院2017年6月-2018年3月收治的T2DM患者80例,随机分为吡格列酮组和二甲双胍组各40例,吡格列酮组采用盐酸吡格列酮片治疗,二甲双胍组采用盐酸二甲双胍片治疗,2组均连续服4个月。比较2组治疗前后的空腹血糖(FPG)、餐后2 h血糖(2hPG)、空腹C肽(FC-P)、糖化血红蛋白(HbA1c)、稳态模型评估胰岛素β细胞分泌指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR),并采用SF-36评估生活质量。结果治疗前2组患者的FPG、2 hPG、FC-P、HbA1c水平比较差异无统计学意义(P>0.05),治疗后2组患者的FPG、2 hPG、HbA1c水平较治疗前改善,吡格列酮组的FC-P水平较治疗前下降,且低于二甲双胍组,差异均有统计学意义(P<0.05)。治疗前2组患者的HOMA-β和HOMA-IR比较差异均无统计学意义(P>0.05);治疗后2组患者的HOMA-β高于治疗前,HOMA-IR均低于治疗前,吡格列酮组治疗后的HOMA-β和HOMA-IR低于二甲双胍组,差异均有统计学意义(P<0.05)。治疗前后2组生理功能、生理职能、躯体疼痛、社会功能、精力、健康状况、情感职能、精神健康评分比较差异均无统计学意义(P>0.05);治疗后2组患者的SF-36各项评分均高于治疗前,差异均有统计学意义(P<0.05)。结论吡格列酮和二甲双胍治疗T2DM患者均能有效降低IR和β细胞功能,提高生活质量,但吡格列酮改善IR效果优于二甲双胍。

Objective To compare the effects of pioglitazone and metformin on insulin resistance and quality of life in patients with type 2 diabetes mellitus(T2DM).Methods A total of 80 patients with T2DM admitted to the hospital from June 2017 to March 2018 were randomly divided into pioglitazone group and metformin group,each of 40 cases.Pioglitazone group was treated with pioglitazone hydrochloride tablets,metformin group was treated with metformin hydrochloride orally,served for 4 months in a row.The fasting blood glucose(FPG),postprandial 2 h blood glucose(2 hPG),fasting C-peptide(FC-P) and glycosylated hemoglobin(HbA1 c) levels were compared before and after treatment.The insulin β-cell secretion index(HOMA-β) and insulin resistance index(HOMA-IR) were evaluated using a steady-state model.The quality of life was assessed using SF-36.Results There were no significant differences in the levels of FPG,2 hPG,FC-P and HbA1c between two groups before treatment(P>0.05).The levels of FPG,2 hPG and HbA1c in two groups were improved after treatment,the level of FC-P in pioglitazone group was lower than that before treatment,and the FC-P level was lower than that in metformin group,the difference was statistically significant(P<0.05).There were no significant differences in HOMA-β and HOMA-IR between two groups before treatment(P>0.05).After treatment,HOMA-β was higher than before treatment,and HOMA-IR was lower than before treatment,the HOMA-β and HOMA-IR of pioglitazone group were lower than those of metformin group,and the difference was statistically significant(P<0.05).There were no significant differences in physiological function,physiological function,physical pain,social function,energy,health status,emotional function and mental health score between two groups before and after treatment(P>0.05).After treatment,the scores of SF-36 in two groups were higher than those before treatment,and the differences were statistically significant(P<0.05).Conclusion Both pioglitazone and metformin can effectively reduce IR and β cell function and improve quality of life,and pioglitazone is better than metformin in improving IR.