达格列净与吡格列酮联合二甲双胍治疗2型糖尿病的疗效及对胰岛素敏感性和胰岛α和β细胞功能的影响

Effect of daglitazone and pioglitazone combined with metformin in the treatment of type 2 diabetes and its influence on insulin sensitivity and islet α and β cell function

目的:探讨达格列净与吡格列酮联合二甲双胍治疗2型糖尿病(T2DM)的疗效及对胰岛素敏感性和胰岛α和β细胞功能的影响。方法:选取100例T2DM患者为研究对象,依据治疗方法不同分为达格列净组和吡格列酮组,每组各50例。达格列净组予以达格列净+二甲双胍治疗;吡格列酮组予以吡格列酮+二甲双胍治疗。比较两组患者血糖指标[空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbAlc)]、血脂指标[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)]、胰岛素抵抗指数(HOMA-IR)、胰岛素敏感性[葡萄糖输注率(GIR)]、胰岛α和β细胞功能指标[α:胰高血糖素曲线下面积(AUCglc);β:早相胰岛素分泌指数(I30/G30)、胰岛素分泌曲线下面积(AUCins)]及不良反应发生情况。结果:治疗后,两组患者FPG、2hPG、HbAlc、TC、TG、LDL-C、HOMA-IR、AUCglc均降低(P<0.05),且达格列净组低于吡格列酮组(P<0.05);GIR、I30/G30、AUCins均升高(P<0.05),且达格列净组高于吡格列酮组(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:达格列净与吡格列酮联合二甲双胍治疗T2DM均可有效改善患者糖脂代谢,减轻IR并可提高胰岛素敏感性,保护胰岛α和β细胞功能,但达格列净联合二甲双胍的作用相对更好。

Objective:To investigate the effect of dapagliflozin and pioglitazone combined with metformin in the treatment of type 2 diabetes mellitus(T2 DM) and its effect on insulin sensitivity and islet α and β cell function.Methods:100 patients with T2 DM were selected and divided into daglitazone group and pioglitazone group according to different treatment methods,with 50 cases in each group.The daglitazone group was treated with daglitazone+metformin,and the pioglitazone group was treated with pioglitazone+ metformin.The blood glucose [fasting plasma glucose(FPG),2 h postprandial blood glucose(2 hPG),glycosylated hemoglobin(HbAlc)],blood lipids [total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C)],insulin resistance [insulin resistance index(HOMA-IR)],insulin sensitivity [glucose infusion rate(GIR) ] and islet α and β cell function [α:area under the curve of glucagon(AUCglc),β:early phase insulin secretion index(I30/G30),area under insulin secretion curve(AUCins)] and adverse effects were compared between the two groups.Results:After treatment,FPG,2 hPG,HbAlc,TC,TG,LDL-C,HOMA-IR and AUCglc in the two groups were significantly decreased,and daglitazone group was lower than the pioglitazone group(P<0.05).GIR,I30/G30 and AUCins were significantly increased(P<0.05),and daglitazone group was higher than the pioglitazone group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion:Dagliptin and pioglitazone combined with metformin in the treatment of T2 DM can effectively improve glucose and lipid metabolism,reduce IR,improve insulin sensitivity,and protect the function of islet α and β cells,and the efficacy of dagliptin is relatively better.