磷酸西格列汀对接受胰岛素强化治疗的初发2型糖尿病患者早期降糖疗效和血糖波动性的影响

韩松梅; 金昕晔; 臧丽; 孙迪; 宋凌云; 郭清华; 窦京涛

doi:10.3969/j.issn.2095-5227.2019.01.002

磷酸西格列汀对接受胰岛素强化治疗的初发2型糖尿病患者早期降糖疗效和血糖波动性的影响

Effectiveness of sitagliptin phosphate on glucose-lowering and glycemic variability in newly diagnosed type 2 diabetes patients treated with intensive insulin therapy

摘要

摘要: 目的探讨二肽基酶4(dipeptidyl peptidase 4,DPP-4)抑制剂磷酸西格列汀对初发2型糖尿病患者胰岛素强化降糖疗效和血糖稳定性的影响。方法选取2017年1-12月于解放军总医院海南医院内分泌科就诊的初发初治糖化血红蛋白水平在9%以上的2型糖尿病患者94例,在胰岛素强化治疗联合二甲双胍治疗的基础上随机分为DPP-4抑制剂(磷酸西格列汀)组和对照组,比较两组治疗后血糖稳定性指标。结果 DPP-4抑制剂组45例,对照组49例,两组年龄、性别、病程、体质量指数(body mass index,BMI)、有无糖尿病家族史、糖化血红蛋白(hemoglobin Alc,HbA1c)、胰岛素分泌指数(homeostasismodel assessment-β,HOMA-β)、胰岛素抵抗指数(homeostasis model assessment-insulin resistance,HOMA-IR),空腹及餐后2 h、胰岛素、C肽等基线资料无统计学差异(P均> 0.05)。治疗7 d后,DPP-4抑制剂组与对照组相比,平均血糖(9.36±1.21) mmol/L vs (10.01±1.48) mmol/L,P=0.024、空腹血糖(8.76±1.10) mmol/L vs (9.37±1.59) mmol/L,P=0.034、餐后血糖(9.94±1.48) mmol/L vs (10.71±1.74) mmol/L,P=0.025、血糖标准差(2.52±0.63) mmol/L vs (2.91±0.90) mmol/L,P=0.021、最大血糖波动幅度(9.34±2.19) mmol/L vs (10.52±2.78) mmol/L,P=0.026、餐后血糖波动幅度(2.59±0.78) mmol/L vs(3.01±1.16) mmol/L,P=0.042、平均血糖波动幅度(5.11±1.31) mmol/L vs (5.83±1.53) mmol/L,P=0.017等血糖波动性指标显著降低,血糖波动次数(6.02±1.88)次vs (7.17±1.77)次,P=0.004、日间血糖平均绝对差(1.26±0.51) mmol/L vs (1.50±0.43) mmol/L,P=0.024、低血糖发生例数3例(6.67%) vs7例(14.29%),P<0.001等指标也显著降低。结论 DPP-4抑制剂能进一步降低胰岛素强化治疗的初发2型糖尿病患者的血糖,并能减少血糖波动性。

Abstract: Objective To access the glucose-lowering effect and glycemic variability of dipeptidyl peptidase 4 inhibitor sitagliptin phosphate combined intensive insulin therapy for newly diagnosed type 2 diabetes patients. Methods A prospective study was conducted in 94 newly diagnosed type 2 diabetes patients with HbA1c above 9% admitted to Hainan Hospital of Chinese PLA General Hospital from January 2017 to December 2017. All the subjects were randomly divided into DPP-4 inhibitor(Sitagliptin)group and control group. The glucose-lowering effect and glycemic variability parameters of two groups were compared. Results There were 45 patients in the DPP-4 inhibitor group, and 49 patients in the control group. No significant difference was found in age, gender,course of disease, BMI, family history, HbA1 c, HOMA-β, HOMA-IR, serum insulin and C peptide between two groups(all P>0.05).At the end of a 7-day therapy, the mean blood glucose(9.36±1.21 mmol/L vs 10.01±1.48 mmol/L, HR=0.024), fasting plasma glucose(8.76±1.10 mmol/L vs 9.37±1.59 mmol/L, HR=0.034), postprandial blood glucose(9.94±1.48 mmol/L vs 10.71±1.74 mmol/L,HR=0.025), standard deviation of blood glucose(2.52±0.63 mmol/L vs 2.91±0.90 mmol/L, HR=0.021), largest amplitude of glycemic excursion(9.34±2.19 mmol/L vs 10.52±2.78 mmol/L, HR=0.026), postprandial glycemic excursion(2.59±0.78 mmol/L vs3.01±1.16 mmol/L, HR=0.042), mean amplitude of glycemic excursions(5.11±1.31 mmol/L vs 5.83±1.53 mmol/L, HR=0.017) in the DPP-4 inhibitor group were significantly lower than those in the control group. Number of glycemic excursions(6.02±1.88 vs7.17±1.77, HR=0.004), mean of daily differences(1.26±0.51 mmol/L vs 1.50±0.43 mmol/L, HR=0.024), incidence of hypoglycemia3 cases(6.67%) vs 7 cases(14.29%), P<0.001 of DPP-4 inhibitor group were also significantly lower than those of control group. Conclusion Dipeptidyl peptidase 4 inhibitors combined with intensive insulin therapy is more effective in terms of glycemic lowering as well as maintaining euglycaemia for newly diagnosed type 2 diabetes patients.

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