西格列汀与维格列汀联合二甲双胍治疗2型糖尿病的有效性及经济性研究

Efficacy and economy of sitagliptin and vildagliptin combined with metformin on treating type 2 diabetes mellitus

目的探讨西格列汀与维格列汀联合二甲双胍治疗2型糖尿病的有效性及经济性。方法选取2019年1—12月延安大学附属医院收治的2型糖尿病患者104例,应用随机数字表法分为西格列汀组与维格列汀组,各52例。西格列汀组在基础干预和二甲双胍治疗基础上联合西格列汀治疗,维格列汀组在基础干预和二甲双胍治疗基础上联合维格列汀治疗,2组均连续治疗14周。比较2组治疗前后血糖、C肽和胰岛素水平,并比较2组临床疗效,不良反应发生率,直接成本,以及成本效果比(C/E)及其敏感性。结果治疗14周后,2组空腹血糖、餐后2 h血糖、糖化血红蛋白水平均低于治疗前,空腹C肽、餐后2 h C肽、空腹胰岛素、餐后2 h胰岛素水平均高于治疗前(均P <0.05),但2组间上述指标水平比较差异均无统计学意义(均P> 0.05)。2组治疗总有效率和不良反应发生率比较差异均无统计学意义(均P> 0.05)。西格列汀组处置费用、检查费用、住院费用、药品费用以及总费用均高于维格列汀组[(714±94)元比(537±71)元,(793±131)元比(676±80)元,(578±64)元比(546±68)元,(1 222±67)元比(953±60)元,(3 189±115)元比(2 829±177)元](均P <0.05),C/E高于维格列汀组(34.54比32.69),将处置费用增加10%、药品费用减少5%后,西格列汀组C/E仍高于维格列汀组(34.66比32.76)。结论西格列汀与维格列汀联合二甲双胍治疗2型糖尿病临床效果相似,但维格列汀联合二甲双胍的经济学价值更高。

Objective To investigate the efficacy and economy of sitagliptin and vildagliptin combined with metformin on treating type 2 diabetes mellitus.Methods From January to December 2019,104 patients with type 2 diabetes mellitus admitted to Yan’an University Affiliated Hospital were enrolled.They were randomly divided into sitagliptin group and vildagliptin group,with 52 cases in each group.The sitagliptin group was treated with sitagliptin on the basis of basic intervention and metformin treatment.The vildagliptin group was treated with vildagliptin on the basis of basic intervention and metformin treatment.Both groups were treated for 14 weeks.The levels of blood glucose,C-peptide and insulin before and after treatment,clinical efficacy,incidence of adverse reactions,direct cost,cost-effectiveness ratio(C/E)and the sensitivity were compared between the two groups.Results After 14 weeks of treatment,the levels of fasting blood glucose,2 h postprandial blood glucose and glycosylated hemoglobin in the two groups were lower than those before treatment,and the levels of fasting C-peptide,2 h postprandial C-peptide,fasting insulin and 2 h postprandial insulin in the two groups were higher than those before treatment(all P<0.05),but there were no significant differences in the above indexes between the two groups(all P>0.05).There were no significant differences in the total effective rate and the incidence of adverse reactions between the two groups(both P>0.05).The disposal cost,examination cost,hospitalization cost,drug cost and total cost in sitagliptin group were higher than those in vildagliptin group[(714±94)yuan vs(537±71)yuan,(793±131)yuan vs(676±80)yuan,(578±64)yuan vs(546±68)yuan,(1222±67)yuan vs(953±60)yuan,(3189±115)yuan vs(2829±177)yuan](all P<0.05).C/E in sitagliptin group was higher than that in vildagliptin group(34.54 vs 32.69).After disposal cost increased by 10%and drug cost decreased by 5%,C/E in sitagliptin group was still higher than that in vildagliptin group(34.66 vs 32.76).Conclusions The clinical efficacy of sitagliptin and vildagliptin combined with metformin on treating type 2 diabetes mellitus is similar,but vildagliptin combined with metformin has higher economic value.