初发2型糖尿病肥胖患者体重管理的5年效果及对血糖的影响  

Effects of metaformin on body weight management and blood glucose control in over-weight patients with newly diagnosed type 2 diabetes

作　　者：李慧[1] 孙明晓[1] 蒋蕾[1] 汪耀[1] 

机构地区：[1]卫生部北京医院内分泌科,100710

出　　处：《中华健康管理学杂志》2013年第5期292-295,共4页Chinese Journal of Health Management

基　　金：科技部＂十五＂科技攻关课题（2001BA702B01）

摘　　要：目的 了解二甲双胍在初发2型糖尿病患者,特别是肥胖和超重患者体重管理的5年效果及对血糖影响.方法 于我院门诊选取新诊断或病程在1年之内的2型糖尿病患者,无急性并发症,入选患者均符合1999年WHO的糖尿病诊断标准,我们从中筛选人组时使用二甲双胍的患者61例,患者平均年龄（50.8±7.9）岁,男性38例,女性23例,根据体质指数将初发2型糖尿病患者分为肥胖组,超重组和正常组,回顾性分析临床诊疗中二甲双胍管理体重的总体效果,采用重复测量资料的方差分析和多元方差分析,比较各组5年随访期间体重的变化趋势以及对血糖的影响.结果受试者随访2年时BMI下降明显[（26.4±2.7）vs.（25.7±2.6）kg/m2,P＜0.05],与此同时空腹血糖（FBS）和糖化血红蛋白（HbA1 c）都有明显下降,与基线相比差异有统计学意义.随访期间肥胖组和超重组体重明显下降,随访2年时分别下降1.5 kg/m2和0.8 kg/m2,与基线相比有统计学意义,而正常组体重则略有上升（0.7 kg/m2）.基线时肥胖组的FBS和HbA1c相对于正常组低（FBS 7.3±0.8vs.11.8±4.8,P＜0.05；HbA1c 6.8±1.2 vs.8.5±3.1,P＜0.05）,而胰岛素水平则高于正常组（2.20±0.36 vs.1.87±0.29,P＜0.05）.随访2年时肥胖组HbA1c降低的幅度最大,肥胖组、超重组、正常组分别平均降低2.5％,1.4％和1.9％,此时肥胖组与正常组胰岛素水平相近.结论 在初发2型糖尿病肥胖和超重患者中使用二甲双胍进行体重的管理,可以明显减轻体重,进而通过改善高胰岛素水平状态有效的降低血糖,最终达到体重和血糖的双重受益.Objective To investigate the effects of metformin on blood glucose control and body weight management in over-weight patients with newly diagnosed type 2 diabetes mellitus （T2DM）.Methods A retrospective study was performed in T2DM patients who were treated with metaformin （male 38,female 23,mean age （50.8 ± 7.9） years old）.Based on body mass index （BMI）,all the participants were assigned to obese,over-weight and normal weight group.Analysis of variance and multivariate analysis were used to confirm the effects of metformin on blood glucose and body weight.Results Fasting blood glucose （FBG）,HbA1 c and BMI were significantly reduced over 2 years.In comparison with baseline,BMI of the obesity and overweight group was significantly decreased during follow up （P ＜ 0.05）,while BMI of the normal weight group increased by 0.7 kg/m2.At baseline,FBS and HbAlc of the obese group were lower than those of the normal weight group （FBS （7.3 ± 0.8） vs.（11.8 ± 4.8） mmol/L,P ＜ 0.05 ; HbA1 c （6.8 ± 1.2） ％ vs.（8.5 ±3.1）％,P ＜0.05）,whereas insulin level was higher than that of the normal weight group （（2.20 ± 0.36） vs.（1.87 ± 0.29） U,P ＜ 0.05）.At 2 years,HbA1 c was reduced on average by 2.5％,1.4％ and 1.9％ in the obesity,over-weight and normal weight group,respectively.Conclusions The present study demonstrates the beneficial effect of metformin on newly diagnosed diabetics,especially obese patients.

关 键 词：人体质量指数 糖尿病 2型 肥胖症 二甲双胍 

分 类 号：R587.1[医药卫生—内分泌]