应用动态血糖监测评价艾塞那肽及地特胰岛素对2型糖尿病患者的疗效  

Evaluation of the Curative Effect of Exenatide and Insulin Detemir on the Treatment of Type 2 Diabetes by Continuous Glucose Monitoring System

作　　者：卢林娜[1] 高政南[1] 朱珠[1] 罗兰[1] 李欣宇[1] 牛敏[1] 侯桂梅[1] 

机构地区：[1]大连市中心医院,辽宁大连116003

出　　处：《中国医药指南》2014年第6期28-31,共4页Guide of China Medicine

摘　　要：目的应用动态血糖监测(CGM)、高胰岛素-正糖钳夹技术(hyperinsuline-mic-euglycemic clamp technique)评价口服降糖药控制不佳的2型糖尿病患者加用艾塞那肽及地特胰岛素对血糖波动、胰岛素敏感性及体质量的影响。方法选取2011年3月至2012年6月于大连市中心医院住院的20例口服降糖药控制不佳的2型糖尿病患者,随机分为艾塞那肽组及地特胰岛素组,在原有治疗方案的基础上加用艾塞那肽及地特胰岛素治疗,治疗期为3个月,测定20例患者治疗前后身高、体质量、糖化血红蛋白(HbA1c)等指标,治疗前后分别应用动态血糖监测及高胰岛素-正糖钳夹技术评估患者的血糖波动、胰岛素敏感性等相关指标。结果经过3个月的治疗,艾塞那肽组及地特胰岛素组HbA1c较前明显下降[分别为(8.31±0.99)vs(6.80±0.77)mmol/L,(8.09±1.66)vs(6.94±1.25)mmol/L(均P<0.05)]。动态血糖监测显示治疗后艾塞那肽组的日平均血糖(MBG)、血糖水平标准差(SDBG)、平均血糖波动幅度(MAGE)较前明显下降[分别为(10.16±0.60)vs(8.26±0.76)mmol/L,(2.25±0.55)vs(1.42±0.50)mmol/L,(5.38±1.65)vs(3.06±1.58)(均P<0.05)],地特胰岛素组上述指标及两组日间平均血糖绝对差(MODD)治疗前后差异无统计学意义(P>0.05)。治疗后艾塞那肽组M值较前明显升高(3.10±1.29 vs(4.44±1.26)mg/(min?kg),P<0.05),体质量及体质量指数(BMI)较前明显下降[分别为(81.85±8.57)vs(79.51±8.24)kg,(28.27±3.39)vs(27.46±3.17)kg/m2,(均P<0.05)],地特胰岛素组M值、体质量及BMI治疗前后差异无统计学意义(P>0.05)。治疗前后两组HbA1c、MBG、SDBG、MAGE、MODD、体质量、BMI及M值比较差异无统计学意义(P>0.05)。治疗期间无严重低血糖发生。结论口服药控制不佳的2型糖尿病患者加用艾塞那肽及地特胰岛素治疗,能有效地控制血糖,同时艾塞那肽尚能减轻血糖波动,改善胰岛素敏感性及减轻体质量,但与地特胰岛素组比较无明显差异Objective To evaluate the change of glycernic excursion, insulin sensitivity and BM/in patients with type 2 diabetes mellitus, who had poor therapeutic effect with oral antidiabetic medications by continuous glucose monitoring system,hyperinsuline-rnic-euglycemic clamp technique. Methods 20 patients with type 2 diabetes failing to achieve glycaemic control with oral antidiabetic medications only in Dalian Municipal Central Hospital from March 2011 to june 2012 were selected, randomly divided into Exenatide group and insulin Detemir group, in the basis of the original treatment plus Exenatide and Detemirt, last for 3 months.The parameters were measured before and after treatment included height, weight, glycated hemoglobin.Using CGM and hyperinsuline-mic-euglycemic clamp technique to assess blood sugar fluctuation, insulin sensitivity etc. Results After 3 months＇ treatment, both Exenatide group and insulin Detemir group have a significant decrease in HbAlc than before respectively[8.31±0.99 vs （6.80±0.77）mmol/L, （8.09±1.66）vs（6.94±1.25）mmogL （all above P〈0.05）].CGM show that MBG, SDBG, MAGE in Exenafide group were significantly decreased than before, respectively [10.16 ±0.60vs（8.26±0.76）mmol/L, （2.25±0.55）vs（1.42±0.50）mmol/L, （5.38± 1.65）vs（3.06±1.58）（all above P〈0.05）], The difference in insulin deternir group of the above indexes and MODD was not statistically significant before and after treatment（P〉0.05）. M value in Exenatide group was significantly increased than before（3.10±1.29）vs（4.44±1.26）mg/（min.kg）,P〈0.05）, body weight and BMI in Exenatide was decreased, respectively[81.85±8.57vs79.51±8.24 kg, （28.27±3.39）vs（27.46±3.17）kg/m2（all above P 〈0.05）]. M value, body weight and BMI in Detemirt group have no statistically significant difference before and atter treatment（P〉0.05）. There was no statistical difference in HbAlc, MBG, SDBG, MAGE, MODD, body weight,BMIand M value.There was no serious hypoglycemia.

关 键 词：糖尿病 2型 艾塞那肽 地特胰岛素 动态血糖监测 正糖钳夹 血糖波动 

分 类 号：R587.1[医药卫生—内分泌]