甘精胰岛素联合二甲双胍治疗初发2型糖尿病伴肥胖症的效果观察

Observation of the effect of insulin glargine combined with metformin in the treatment of newly diagnosed type 2 diabetes mellitus with obesity

目的甘精胰岛素联合二甲双胍治疗初发2型糖尿病伴肥胖症的临床疗效。方法选取2018年9月至2019年9月本院收治的78例初发2型糖尿病伴肥胖症患者作为研究对象,采用随机数字表法分为联合组与对照组,每组39例。对照组给予口服盐酸二甲双胍治疗,联合组在对照组基础上联合甘精胰岛素皮下注射治疗,比较两组治疗前后血糖指标、体重指数(BMI)、空腹C肽、胰岛素抵抗指数(HOMA-IR)、受控衰减参数(CAP)水平及不良反应发生率。结果治疗前,两组BMI、空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)水平比较差异无统计学意义;治疗后,两组BMI、FPG、2 h PG、HbA1c水平均低于治疗前,且联合组低于对照组,差异有统计学意义(P<0.05)。治疗前,两组空腹C肽、HOMA-IR、CAP水平比较差异无统计学意义;治疗后,两组空腹C肽水平均高于治疗前,HOMA-IR、CAP水平均低于治疗前,且联合组空腹C肽水平高于对照组,HOMA-IR、CAP水平均低于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义。结论甘精胰岛素联合二甲双胍治疗初发2型糖尿病伴肥胖症疗效显著,可明显改善患者血糖指标,控制体质量,降低胰岛素抵抗指数,改善胰岛功能,减轻肝脂肪变性程度,且不良反应发生少,值得临床推广应用。

Objective To evaluate the clinical efficacy of insulin glargine combined with metformin in the treatment of newly diagnosed type 2 diabetes mellitus with obesity.Methods 78 patients with newly diagnosed type 2 diabetes mellitus and obesity who were admitted to our hospital from September 2018 to September 2019 were selected as the research subjects,and they were divided into combination group and control group according to random number table method,with 39 cases in each group.The control group was given oral metformin hydrochloride,the combination group was given subcutaneous injection of insulin glargine on the basis of the control group,and the levels blood glucose index,body mass index(BMI),fasting C-peptide,homeostasis model assessment-insulin resistance(HOMA-IR),controlled attenuation parameter(CAP)and the incidence of adverse reactions were compared between the two groups before and after treatment.Results Before treatment,there was no significant difference in the levels of BMI,fasting blood glucose(FPG),2 hour postprandial glucose(2 h PG),and glycated hemoglobin A1c(HbA1c)between the two groups;after treatment,the levels of BMI,FPG,2 h PG,and HbA1c in the two groups were lower than those before treatment,and the combination group was lower than the control group,and the difference was statistically significant(P<0.05).Before treatment,there was no significant difference in the levels of fasting C-peptide,HOMA-IR and CAP between the two groups;after treatment,the levels of fasting C-peptide in the two groups were higher than those before treatment,and the levels of HOMA-IR and CAP were lower than those before treatment,and the level of fasting C-peptide in the combination group was higher than that in the control group,and the levels of HOMA-IR and CAP were lower than those in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups.Conclusion Insulin glargine combined with metformin has significant effect in the treatment of newly diagnosed type 2 diabetes mellitus with obesity,which can significantly improve the blood glucose index,control body weight,reduce insulin resistance index,improve islet function,and the degree of hepatic steatosis,and have fewer adverse reactions,it is worthy of clinical application.