瑞格列奈联合二甲双胍治疗对老年2型糖尿病患者血糖波动和氧化应激的影响

Effects of repaglinide combined with metformin on blood glucose fluctuation and oxidative stress in elderly patients with type 2 diabetes mellitus

目的探讨瑞格列奈联合二甲双胍治疗老年2型糖尿病的临床效果,并观察其对患者血糖波动及氧化应激的影响。方法前瞻性选取2018年5月至2019年6月于青海油田职工总医院治疗的老年2型糖尿病患者100例进行研究,并随机分为观察组与对照组,每组50例。在常规治疗的基础上,对照组给予盐酸二甲双胍片治疗,观察组给予盐酸二甲双胍片与瑞格列奈联合治疗,疗程3个月。比较两组患者治疗有效率及不良反应发生率,记录其治疗前、治疗3个月后血糖指标、胰岛素抵抗、氧化应激指标变化情况。结果观察组治疗有效率88.00%显著高于对照组68.00%,差异有统计学意义(P<0.05)。治疗后,两组患者血糖[空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、一日内平均血糖波动幅度(MAGE)]均较治疗前显著降低,且观察组治疗后以上指标较对照组降低更显著(P<0.05)。治疗后,两组患者胰岛素指标较治疗前HOMA-β显著升高、Homa-IR显著降低,观察组FNS较治疗前显著降低(P<0.05),且观察组治疗后以上指标较对照组变化更显著(P<0.05)。治疗后,两组患者氧化应激指标丙二醛(MDA)、8-异前列腺素2a(8-iso-PGF2a)均较治疗前显著降低(P<0.05),超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-PX)、6-酮-前列腺素F-1a(6-Keto-PGF-1a)均较治疗前显著升高(P<0.05),且观察组治疗后以上指标较对照组变化更显著(P<0.05)。治疗期间,观察组与对照组不良反应发生率分别为10.00%和18.00%,差异无统计学意义(P>0.05)。结论瑞格列奈联合二甲双胍对老年2型糖尿病具有很好的治疗效果,可有效控制血糖及胰岛素水平,缓解氧化应激反应,安全性高,值得推广使用。

Objective To investigate the clinical effects of repaglinide combined with metformin in the treatment of elderly patients with type 2 diabetes mellitus,and to observe its effects on blood glucose fluctuation and oxidative stress.Methods A total of 100 elderly patients with type 2 diabetes mellitus who were treated in Qinghai Oilfield Staff General Hospital from May 2018 to June 2019 were selected for the study.They were randomly divided into observation group and control group,with 50 cases in each group.On the basis of routine treatment,control group was given metformin hydrochloride tablets,and observation group was treated with metformin hydrochloride and repaglinide,and they were treated for 3 months.The effective rate of treatment and incidence rate of adverse reactions were compared between the two groups,and the blood glucose indexes,insulin resistance and oxidative stress indexes were recorded before treatment and after 3 months of treatment.Results The effective rate of treatment in observation group was significantly higher than that in control group(88.00%vs.68.00%,P<0.05).After treatment,the blood glucose indexes[fasting plasma glucose(FPG),postprandial 2 h blood glucose(2 h PG),glycosylated hemoglobin(HbA1c),mean amplitude of glycemic excursions(MAGE)within 1d]were significantly decreased in the two groups,and the indexes in observation group after treatment were significantly different from those in control group(P<0.05).After treatment,the insulin indexes in the two groups showed that HOMA-βwas significantly increased(P<0.05),while Homa-IR was significantly decreased(P<0.05),and the FNS in observation group was significantly decreased(P<0.05),and the indexes in observation group after treatment were significantly different from those in control group(P<0.05).After treatment,the oxidative stress indexes showed that malondialdehyde(MDA)and 8-iso-prostaglandin2a(8-iso-PGF2a)were significantly decreased(P<0.05)while superoxide dismutase(SOD),glutathione peroxidase(GSH-PX)and 6-keto-prostaglandin F-1a(6-Keto-PGF-1a)were significantly increased(P<0.05),and the indexes in observation group were significantly different from those in control group after treatment(P<0.05).During treatment,the incidence rates of adverse reactions in observation group and control group were 10.00%and 18.00%respectively,and the difference in the incidence rate of adverse reactions was not statistically significant(P>0.05).Conclusion Repaglinide combined with metformin has a good therapeutic effect on elderly type 2 diabetes mellitus.It can effectively control blood glucose and insulin and relieve oxidative stress response,with high safety.Thus it is recommended for promotion and application.