沙格列汀联合预混胰岛素治疗2型糖尿病的效果及其对血糖波动的影响

Effect of saxagliptin combined with premixed insulin on blood glucose fluctuation in patients with type 2 diabetes mellitus

目的:探讨沙格列汀联合预混胰岛素治疗2型糖尿病的效果及其对血糖波动的影响。方法:选取2017年5月至2018年3月广西医科大学第一附属医院老年内分泌科收治的100例2型糖尿病患者,按随机数字表法分为观察组和对照组,每组50例,其中对照组给予门冬胰岛素30注射液治疗,观察组给予沙格列汀联合门冬胰岛素30注射液治疗。检测两组患者治疗前、后空腹血糖(FBG)、餐后2h血糖(2hPG)、三酰甘油(TG)、胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、糖化血红蛋白(HbA1c)、空腹胰岛素(Fins)、空腹血清C肽(FCP)及餐后2hC肽(2hCP)水平,计算胰岛β细胞功能指数(HOMA-β)和胰岛素抵抗指数(HOMA-IR),并应用动态血糖监测系统监测24h平均血糖水平。结果:治疗后,观察组HbA1c、FBG、2hBG、LDL-C、HOMA-IR显著低于治疗前及对照组,2hCP显著高于治疗前及对照组(均P<0.05)。治疗后,观察组TG水平显著低于治疗前,HDL-C、FCP、HOMA-β水平显著高于治疗前(P<0.05),但与对照组比较差异无统计学意义(P>0.05)。观察组午餐前1h、晚餐前1h、早餐后3h、午餐后3h、晚餐后3h平均血糖水平、日内血糖平均波动幅度及日间血糖平均绝对差均显著低于对照组(均P<0.05)。结论:沙格列汀联合预混胰岛素对2型糖尿病患者的血糖控制效果更佳,并能降低血糖波动。

Objective: To investigate the effect of saxagliptin combined with premixed insulin on blood glucose fluctuation in patients with type 2 diabetes mellitus. Methods: 100 patients with type 2 diabetes admitted to our hospital from May 2017 to March 2018 were randomly divided a control group and an observation group,with 50 cases in each group.The patients in the control group were treated with insulin aspart 30 injection,and those in the observation group were treated with saxagliptin combined with insulin aspart 30 injection.Fasting blood glucose (FBG),postprandial 2h blood glucose (2 hBG),triglyceride (TG),cholesterol (TC),high-density lipoprotein (HDL-C),and low-density lipoprotein (LDL-C),glycosylated hemoglobin (HbA1c),fasting insulin (Fins),fasting serum C-peptide (FCP) and postprandial 2 h C peptide (2 h CP) levels were measured before and after treatment.The islet β-cell function index (HOMA-β) and insulin resistance index (HOMAIR) were calculated.The 24-hour average blood glucose level was monitored using a dynamic blood glucose monitoring system. Results: After treatment,the HbA1c,FBG,2 h BG,LDL-C and HOMA-IR in the observation group were significantly lower than those in the control group,and the 2 h CP level was higher ( P <0.05).There were no significant differences in the HDL-C,FCP and HOMA-β levels between the two groups ( P >0.05).The average blood glucose level of the observation group at 1 h before lunch,1 h before dinner,3 h after breakfast,3 h after lunch,3 h after dinner,and the average fluctuation of blood glucose during the day and the average absolute difference of blood glucose during the day were significantly lower than those of the control group ( P <0.05). Conclusion: Saxagliptin combined with premixed insulin could greatly control the blood glucose and reduce blood glucose fluctuationin patients with type 2 diabetes.