吡格列酮与甘精胰岛素联合治疗磺脲类药物继发失效2型糖尿病患者的临床研究

Clinical Study of Pioglitazone Combined with Insulin Glargine in the Treatment of Patients with Type-2 Diabetes Mellitus Secondary to Failure of Sulfonylureas

目的探讨吡格列酮与甘精胰岛素联合治疗磺脲类药物继发失效2型糖尿病(T2DM)患者的临床疗效。方法选取唐河县卫生学校附属医院2019年1月至2020年12月收治的磺脲类药物继发失效T2DM患者92例,采用电脑随机数字表法按照1∶1配对原则分为对照组(N=46)及观察组(N=46)。对照组给予甘精胰岛素治疗,观察组给予甘精胰岛素+吡格列酮治疗,两组均治疗6个月。对比两组治疗前及治疗6个月后血糖[糖化血红蛋白(HbAlc)、空腹血糖(FPG)、餐后2 h血糖(2 h PG)]、低密度脂蛋白胆固醇(LDL-C)、胰岛素用量、餐后2 hC肽(2 h CP)、高密度脂蛋白胆固醇(HDL-C)、体质量指数、空腹C肽(FCP)、血压、总胆固醇(TC)、胰岛素分泌、甘油三酯(TG)、生活质量、安全性。结果治疗6个月后,观察组HbA1c、FPG、2 h PG、TG水平、体重指数、胰岛素日用量、收缩压、舒张压、空腹胰岛素及餐后2 h胰岛素均低于对照组,差异有统计学意义(P<0.05),HDL-C水平、生活质量高于对照组,差异有统计学意义(P<0.05),两组FCP、2 h CP、LDL-C、TC水平比较,差异无统计学意义(P>0.05),观察组不良反应发生率(6.52%)低于对照组(21.74%),差异有统计学意义(P<0.05)。结论磺脲类药物继发失效T2DM患者采用吡格列酮联合甘精胰岛素治疗能有效降低血糖水平,纠正胰岛素抵抗,改善血压情况,且安全性高。

Objective To investigate the clinical efficacy of pioglitazone combined with insulin glargine in the treatment of patients with type 2 diabetes mellitus(T2DM)secondary to failure of sulfonylureas.Methods A total of 92 patients with T2DM secondary to failure of sulfonylureas who were treated in our hospital from January 2018 to December 2020 were selected and divided into the control group(N=46)and the observation group(N=46)according to the 1∶1 matching principle by computer random number table method.The control group was given insulin glargine treatment,and the observation group was given insulin glargine combined with pioglitazone treatment,both groups were treated for 6 months.Blood glucose[glycated hemoglobin(HbAlc),fasting blood glucose(FPG),2 h postprandial blood glucose(2 h PG)],insulin dosage,2 h postprandial C-peptide(2 h CP),body mass index,fasting C-peptide(FCP),blood pressure,insulin secretion,blood lipids[low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),total cholesterol(TC),triglyceride(TG)],quality of life,safety were compared between two groups before and after treatment.Results After 6 months of treatment,the HbA1c,FPG,2 h PG,TG,BMI,daily insulin dosage,systolic blood pressure,diastolic blood pressure,fasting insulin and 2 h postprandial insulin in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05),the HDL-C level and quality of life in the observation group were higher than those in the control group(P<0.05),but there were no significant differences in FCP,2 h CP,LDL-C and TC levels between the two groups.During the treatment,the total incidence of adverse reactions in the observation group was 6.52%lower than that in the control group(21.74%),and the difference was statistically significant(P<0.05).Conclusion Pioglitazone combined with insulin glargine can effectively reduce blood glucose levels,correct insulin resistance,and improve blood pressure in T2DM patients with secondary failure of sulfonylureas with high safety.