达格列净或那格列奈联合甘精胰岛素治疗2型糖尿病临床观察

Clinical Observation of Dapagliflozin or Nateglinide Combined with Insulin Glargine in the Treatment of Type 2 Diabetes Mellitus

目的:观察达格列净或那格列奈在联合甘精胰岛素治疗2型糖尿病患者中的疗效和安全性。方法:血糖控制不佳,糖化血红蛋白(HbA1c)>8%,空腹血糖(FBG)11~16 mmol·L^-1的2型糖尿病患者76例随机分为两组各38例,观察组给予达格列净片联合甘精胰岛素治疗,对照组给予那格列奈片联合甘精胰岛素治疗。两组均随访12周,以FBG<7.0 mmol·L^-1,HbA1c<7%作为控制目标。比较两组患者血糖控制、低血糖事件及体重指数(BMI)变化。结果:治疗后,两组患者的FBG、2hPG、HbA1c均较治疗前明显下降(P<0.01),但两组各项指标差值无明显差异(P>0.05);两组患者治疗前后BMI比较,差异有统计学意义(P<0.01)。2组患者的血糖达标时间与胰岛素用量差异无统计学意义(P>0.05)。观察组低血糖事件发生率为2.6%,显著低于对照组的13.2%(P<0.01)。结论:达格列净或那格列奈联合甘精胰岛素均能有效控制2型糖尿病患者的FBG、2hPG、HbA1c等血糖指标,而达格列净组低血糖发生率更低,同时还具有控制体重的优势。

Objective:To investigate the efficacy and safety of dapagliflozin or nateglinide in combination with insulin glargine in the treatment of type 2 diabetes mellitus.Methods:Seventy-six type 2 diabetes mellitus patients with glycosylated hemoglobin(HbA1 c)>8%and fasting blood sugar(FBG)ranged 11-16 mmol·L^-1 were randomly divided into two groups.The treatment group(dapagliflozin+insulin glargine group,38 cases)and the control group(nateglinide+insulin glargine group,38 cases)were treated and followed up for 12 weeks.FBG<7.0 mmol·L^-1 and HbA1 c<7%were set up as the control targets.Then the blood glucose,occurrence of hypoglycemia and the change of body weight between two groups were compared.Results:After treatment,FBG,2 hPG and HbA1 c of the two groups were decreased significantly than before(P<0.01),but there was no significant difference in the indicators between the two groups(P>0.05).There was significant difference in BMI between the two groups before and after treatment(P<0.01).Therapeutic time and insulin dose has no significance between the two groups(P>0.05).The incidence of hypoglycemic events in the observation group was 2.6%,significantly lower than that in the control group,which was 13.2%(P<0.01).Conclusion:Both dapagliflozin and nateglinide combined with insulin glargine can effectively control FBG,2 hPG and HbA1 c in type 2 diabetes mellitus,but the dapagliflozin group has lower hypoglycemia incidence and better weight control.