加用维格列汀对胰岛素治疗的2型糖尿病患者无症状低血糖发生率的影响

Effect of vildagliptin on incidence of asymptomatic hypoglycemia in insulin-treated patients with type 2 diabetes

目的观察接受胰岛素治疗的2型糖尿病患者加用二肽基肽酶Ⅳ抑制剂维格列汀后,其低血糖(包括无症状低血糖事件)发生率能否降低。方法将2018年3月至9月于我院内分泌科接受胰岛素治疗的80例2型糖尿病患者随机分为研究组(联用维格列汀共40例)和对照组(不联用二肽基肽酶Ⅳ抑制剂共40例),监测其4周内发生的低血糖事件(包括无症状低血糖),比较两组发生低血糖的例数及事件数,并观察4周后所有患者血糖参数的变化。结果研究组和对照组发生低血糖总人数(18例次对23例次)[包括无症状低血糖的人数(10例次对16例次)]差异无统计学意义(P>0.05);研究组无症状低血糖事件数(14例次对27例次)少于对照组(P<0.05),总低血糖事件数(33例次对52例次)亦少于对照组(P<0.05)。Poisson回归分析显示无感知低血糖事件的发生与糖尿病病程(P<0.01)、空腹血糖(P<0.05)和研究组别(P<0.05)相关。4周后研究组和对照组的糖化血红蛋白、糖化白蛋白、空腹和餐后血糖均改善(P<0.05)。结论在接受胰岛素治疗的2型糖尿病患者中,加用维格列汀在改善其血糖控制同时,亦可降低无症状低血糖事件的发生率并减少总低血糖事件的发生。

Objective To investigate whether the incidence of hypoglycemia(including asymptomatic hypoglycemia events)can be reduced in type 2 diabetic patients treated with insulin plus the dipeptidyl peptidaseⅣinhibitor vildagliptin.Method A total of 80 patients with type 2 diabetes who were treated with insulin in our hospital during March to September 2018 were randomly divided into two groups:the study group(40 patients with combination of vildaglitin)and the control group(40 patients without combination of dipeptidyl peptidaseⅣinhibitor).The hypoglycemic events(including asymptomatic hypoglycemia)within 4 weeks were monitored,compared with the number of hypoglycemic cases and events in the two groups,and the changes of blood glucose parameters in all patients after 4 weeks were observed.Results There was no significant difference in the total number of hypoglycemia(18 cases vs 23 cases)between the study group and the control group[including the number of asymptomatic hypoglycemia(10 cases vs 16 cases)](P>0.05).The number of asymptomatic hypoglycemia events in the study group(14 times vs 27 times)was less than that in the control group(P<0.05),and the total number of hypoglycemia events(33 times vs 52 times)was less than that in the control group(P<0.05).Poisson regression analysis showed that the incidence of non-perceived hypoglycemia was related to the course of diabetes(P<0.01),fasting blood glucose(P<0.05)and study group(P<0.05).After 4 weeks,the glycosylated hemoglobin,glycosylated albumin,fasting and postprandial blood glucose in the study group and the control group were all improved(P<0.05).Conclusion In the patients with type 2 diabetes mellitus treated with insulin,the addition of vildagliptin can not only improve their blood glucose control,but also reduce the incidence of asymptomatic hypoglycemic events and the total number of hypoglycemic events.