观察艾塞那肽和利拉鲁肽对进行持续皮下胰岛素输注治疗的新诊断2型糖尿病患者的临床疗效

Observation on the clinical efficacy of the treatment of newly diagnosed type 2 diabetes mellitus with the use of exenatide and liraglutide

目的观察进行持续皮下胰岛素输注治疗的新诊断2型糖尿病患者采用艾塞那肽和利拉鲁肽治疗的效果。方法120例新诊断2型糖尿病患者,以随机双盲法分为对照组、观察A组及观察B组,每组40例。三组患者均进行持续皮下胰岛素输注治疗,待血糖稳定后再实施进一步治疗,其中,对照组患者采用二甲双胍治疗,观察A组患者采用利拉鲁肽治疗,观察B组患者采用艾塞那肽治疗。对比三组患者治疗前后的血糖指标[空腹血糖(FPG)、餐后2 h血糖(2 h PBG)、糖化血红蛋白(HbA1c)]及血脂指标[甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]水平,不良反应发生情况。结果对照组治疗后的FPG、2 h PBG、HbA1c分别为(8.2±2.0)mmol/L、(8.6±1.6)mmol/L、(7.9±1.1)%,观察A组治疗后的FPG、2 h PBG、HbA1c分别为(6.8±1.4)mmol/L、(7.0±1.5)mmol/L、(7.0±0.7)%,观察B组治疗后的FPG、2 h PBG、HbA1c分别为(7.4±1.2)mmol/L、(7.8±1.8)mmol/L、(7.4±0.8)%。治疗后,三组患者的FPG、2 h PBG、HbA1c均低于本组治疗前,且观察A组及观察B组的FPG、2 h PBG、HbA1c均低于对照组,观察A组的FPG、2 h PBG、HbA1c均低于观察B组,差异具有统计学意义(P<0.05)。对照组治疗后的TG、TC、LDL-C、HDL-C分别为(2.1±0.9)、(5.8±1.2)、(3.0±1.0)、(1.2±0.9)mmol/L,观察A组治疗后的TG、TC、LDL-C、HDL-C分别为(1.6±0.8)、(5.1±0.8)、(2.7±0.5)、(1.4±0.5)mmol/L,观察B组治疗后的TG、TC、LDL-C、HDL-C分别为(1.5±0.9)、(5.0±0.6)、(2.4±0.8)、(1.5±0.8)mmol/L。治疗后,观察A组及观察B组的TG、TC、LDL-C均低于本组治疗前,HDL-C高于本组治疗前,差异具有统计学意义(P<0.05);对照组治疗后的TG、TC、LDL-C、HDL-C与本组治疗前对比,差异无统计学意义(P>0.05)。治疗后,观察A组及观察B组的TG、TC、LDL-C均低于对照组,HDL-C高于对照组,且观察B组的LDL-C低于观察A组,差异具有统计学意义(P<0.05);治疗后观察A组及观察B组的TG、TC、HDL-C对比,差异无统计学意义(P>0.05)。三组患者的不良反应发生率两两对比,差异无统计学意义(P>0.05)。结论利拉鲁肽及艾塞那肽用于进行持续皮下胰岛素输注治疗的新诊断2型糖尿病患者中,改善血糖及血脂的效果均优于二甲双胍。其中,利拉鲁肽降血糖效果较好,而艾塞那肽对LDL-C指标的控制效果更好。

Objective To observe the effect of the treatment of newly diagnosed type 2 diabetes mellitus with the use of exenatide and liraglutide.Methods A total of 120 patients with newly diagnosed type 2 diabetes mellitus were randomly divided into control group,observation group A and observation group B according to the random double-blind method,with 40 cases in each group.All patients in the three groups were treated with continuous subcutaneous insulin infusion,and further treatment was performed after blood glucose stabilization.Among them,patients in the control group were treated with metformin,patients in observation group A were treated with liraglutide,and patients in observation group B were treated with exenatide.Comparison was made on levels of blood glucose[fasting plasma glucose(FPG),2 h postprandial blood glucose(2 h PBG),glycosylated hemoglobin(HbA1c)]and lipid indexes[triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)]before and after treatment and the occurrence of adverse reactions among the three groups.Results After treatment,FPG,2-h PBG,and HbA1c were(8.2±2.0)mmol/L,(8.6±1.6)mmol/L,and(7.9±1.1)%in the control group,(6.8±1.4)mmol/L,(7.0±1.5)mmol/L,(7.0±0.7)%in observation group A,and(7.4±1.2)mmol/L,(7.8±1.8)mmol/L,(7.4±0.8)%in observation group B.After treatment,FPG,2 h PBG,and HbA1c in all three groups were lower than those before treatment in this group;FPG,2 h PBG,and HbA1c in observation group A and observation group B were lower than those in the control group;the differences were statistically significant(P<0.05).After treatment,TG,TC,LDL-C,and HDL-C were(2.1±0.9),(5.8±1.2),(3.0±1.0),and(1.2±0.9)mmol/L in the control group,(1.6±0.8),(5.1±0.8),(2.7±0.5),and(1.4±0.5)mmol/L in observation group A,and(1.5±0.9),(5.0±0.6),(2.4±0.8),and(1.5±0.8)mmol/L in observation group B.After treatment,TG,TC and LDL-C in observation group A and observation group B were lower than those before treatment in this group,and HDL-C was higher than that before treatment in this group.The differences were statistically significant(P<0.05).In the control group,the differences in TG,TC,LDL-C and HDL-C before and after treatment were not statistically significant(P>0.05).After treatment,TG,TC and LDL-C in observation group A and observation group B were lower than those in the control group,and HDL-C was higher than that in the control group;LDL-C in observation group B was lower than that in observation group A;the differences were statistically significant(P<0.05).After treatment,there was no statistically significant difference in TG,TC and HDL-C between observation group A and observation group B(P>0.05).There was no statistically significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion Continuous subcutaneous insulin infusion of liraglutide and exenatide is superior to metformin in improving blood glucose and lipids in patients with newly diagnosed type 2 diabetes mellitus.Among them,liraglutide has better hypoglycemic effect,while exenatide has better control effect on LDL-C index.