沙格列汀联合胰岛素泵短期强化降血糖治疗对2型糖尿病患者β细胞分泌功能及胰岛素抵抗的影响

Effects of short-term intensive hypoglycemic therapy with insulin pump combined with saxagliptin on secretion function of glandular cells and insulin resistance in patients with type 2 diabetes mellitus

目的探讨沙格列汀联合胰岛素泵短期强化降血糖治疗对2型糖尿病患者β细胞分泌功能及胰岛素抵抗的影响.方法选择上海市奉贤区中心医院2017年5月-2018年5月收治的101例2型糖尿病患者,根据随机数字表法分为观察组(52例)及对照组(49例).对照组给予胰岛素泵短期强化治疗,观察组在对照组基础上给予二肽基肽酶Ⅳ(DPP-4)抑制剂沙格列汀,两组治疗疗程均为2周.对比两组患者临床疗效、治疗前后的血糖相关指标、胰岛素β细胞功能变化、血糖达标时间、胰岛素日用量、低血糖发生率及血糖达标率.结果治疗后,观察组总有效率为88.5%,显著高于对照组的73.5%(P<0.05).治疗后,两组的空腹血糖(FPG)、餐后2h血糖(2 h PG)均明显低于治疗前,胰岛β细胞功能指数(HOMA-β)、C肽水平(C-p2)均明显高于治疗前,同组治疗前后比较差异均有统计学意义(P<0.05);且治疗后观察组的C-p2明显高于对照组(P<0.05).对照组的胰岛素抵抗指数(HOMA-IR)治疗前后对比无统计学意义;治疗后观察组的HOMA-IR明显低于治疗前和对照组,差异有统计学意义(P<0.05).观察组的血糖达标时间及胰岛素日用量明显低于对照组,血糖达标率明显高于对照组,组间差异有统计学意义(P<0.05).两组低血糖发生率对比无统计学意义.结论沙格列汀联合胰岛素泵短期强化降血糖治疗2型糖尿病可更快、平稳的控制血糖,更好的改善胰岛β细胞分泌功能及胰岛素抵抗.

Objective To investigate the effects of short-term intensive hypoglycemic therapy with insulin pump combined with saxagliptin on the secretion function of β cells and insulin resistance in patients with type 2 diabetes mellitus.Methods Patients(101 cases)with type 2 diabetes mellitus from May 2017 to May 2018 in Central Hospital of Shanghai Fengxian District were chosen,and who were divided into the observation group(52 cases)and control group(49 cases)according randomly number methods.The control group were given short-term intensive hypoglycemic therapy with insulin pump,the observation group were given saxagliptin on the base of control group.Patients in two groups were treated for 2 weeeks.The clinical efficacy was compared,and the blood glucose indexes,changes of insulinβcells functions before and after treatment in two groups were compared.The time of blood glucose reaching the standard,daily dosage of insulin,incidence of hypoglycemia,and the rate of reaching the standard of blood glucose of two groups were compared.Results After treatment,the total efficacy of observation group was 88.5%,which was obviously higher than 73.5%in the control group(P<0.05).After treatment,the FPG,2 h PG of two groups were decreased than before,the HOMA-β,C-p2 were higher than before(P<0.05),and the C-p2 in the observation group was higher than control group after treatment(P<0.05).The HOMA-IR of control group had no significant different between before and after treatment.The HOMA-IR of observation group after treatment was obviously lower than before(P<0.05).The reaching time of the blood glucose standard and the daily dosage of insulin in the observation group were significantly lower than control group,and the reaching rate of the blood glucose standard was significantly higher than that in the control group(P<0.05).The incidence of hypoglycemia in two groups was not statistically significant.Conclusion The short-term enhancement of insulin pump and saxagliptin in treatment of type 2 diabetes mellitus could control blood glucose more rapidly and steadily,and improve the secretion function of islet hypoxia cells and insulin resistance.