地特胰岛素联合利拉鲁肽治疗血糖控制不佳2型糖尿病患者的临床观察  

The observation of blood glucose fluctuations in patients with type 2 diabetes mellitus using Liraglutide combine with insulin detemir as basic insulin

作　　者：王平[1] 赵蕾[1] 徐锌 张彩香[1] 李意[1] 梁艳玲[1] 曲建昌[1] 祝开思[1] 

机构地区：[1]中国人民解放军305医院内分泌科,北京100017

出　　处：《中国糖尿病杂志》2015年第6期524-526,共3页Chinese Journal of Diabetes

基　　金：糖尿病防治研究北京市重点实验室资助课题(2013TNBF03)

摘　　要：目的评价地特胰岛素联合利拉鲁肽治疗血糖控制不佳的T2DM患者疗效。方法选取预混胰岛素治疗血糖控制不佳的T2DM患者32例,采用地特胰岛素联合利拉鲁肽治疗方案,比较治疗前后各项指标,采用动态血糖监测系统(CGMS)评价血糖漂移水平、血糖曲线下面积(AUCPG)和低血糖发生率等情况。结果治疗后BMI[(27.25±2.32)vs(26.50±2.30)kg/m2]、SBP[(137.22±17.42)vs(126.55±10.08)mmHg]、DBP[(85.00±9.54)vs(78.22±6.45)mmHg]、FPG[(10.19±2.99)vs(6.52±1.24)mmol/L]、2hPG[(15.61±4.37)vs(10.51±1.36)mmol/L]、HbA1c[(8.57±1.64)%vs(7.26±1.11)%]、TC[(5.11±1.51)vs(4.19±0.48)mmol/L]、LDL-C[(3.13±0.73)vs(2.55±0.64)mmol/L]和胰岛素抵抗指数(HOMA-IR)[(3.79±1.98)vs(2.60±1.63)]较治疗前下降(P<0.05或P<0.01),FC-P[(2.72±1.57)vs(4.73±2.39)ng/ml]、2hC-P[(6.93±2.20)vs(13.33±3.39)ng/ml]和HDL-C[(1.00±0.27)vs(1.21±0.19)mmol/L]较治疗前上升(P<0.01)。CGMS结果显示,治疗后血糖平均值[(7.90±0.33)vs(6.90±0.10)mmol/L]、血糖漂移系数[(1.87±0.25)vs(1.07±0.11)]、血糖漂移最大幅度[(8.22±1.69)vs(1.22±0.69)mmol/L]、血糖>7.8mmol/L AUCPG[(27.46±6.20)vs(17.46±2.30)]及血糖>11.1 mmol/L AUCPG[(6.20±3.52)vs(2.02±0.25)]、低血糖发生率(45.45%vs 3.12%)较治疗前降低(P<0.01)。结论地特胰岛素联合利拉鲁肽可有效降低患者BMI、血压、血糖、血脂、HOMA-IR和血糖漂移水平,且低血糖发生率低。Objective To observe the curative effect of Liraglutide combine with insulin detemir treatment in T2 DM patients.Methods 32 cases of poor blood glucose control of T2 DM patients using insulin detemir combine with Liraglutide given with subcutaneous for 12 weeks.Before and after the treatment,general and biochemical data were observed.The glucose excursions,the area under the glucose（AUCPG）and the incidence of hypoglycemia were evaluated according to continuous glucose monitoring system（CGMS）.Results After the treatment of liralutide and insulin detemir,BMI[（27.25±2.32）vs（26.50±2.30）kg/m2],SBP [（137.22±17.42）vs（126.55±10.08）mmHg],DBP [（85.00±9.54）vs（78.22±6.45）mmHg],FPG [（10.19±2.99）vs（6.52±1.24）mmol/L],2hPG[（15.61±4.37）vs（10.51±1.36）mmol/L],HbA1c[（8.57±1.64）% vs（7.26±1.11）%],TC [（5.11±1.51）vs（4.19±0.48）mmol/L],LDL-C [（3.13±0.73）vs（2.55±0.64）mmol/L]and HOMA-IR [（3.79±1.98）vs（2.60±1.63）]decreased significantly（P〈0.05 or P〈0.01）,FC-P[（2.72±1.57）vs（4.73±2.39）ng/ml],2hC-P[（6.93±2.20）vs（13.33±3.39）ng/ml]and HDL-C [（1.00±0.27）vs（1.21±0.19）mmol/L]increased significantly（P〈0.01）.The results of CGMS showed that,mean glucose value[（7.90±0.33）vs（6.90±0.10）mmol/L],glucose excursions cefficient [（1.87±0.25）vs（1.07±0.11）],glucose excursions aplitude peak[（8.22±1.69）vs（1.22±0.69）mmol/L],glucose〉7.8mmol/L AUCPG[（27.46±6.20）% vs（17.46±2.30）%]and glucose〉11.1 mmol/L AUCPG [（6.20±3.52）% vs（2.02±0.25）%],the incidence of hypoglycemia（3.12% vs 45.45%）decreased significantly（P〈0.01）.Conclusion The use of liralutide and insulin detemir are safe and effective in improvement of BMI,blood pressure,blood glucose,blood lipids and HOMA-IR.Also the glucose excursions is lower than before,and also have lower risk of hypoglycemia.

关 键 词：糖尿病 2型 地特胰岛素 利拉鲁肽 动态血糖监测系统 

分 类 号：R587.1[医药卫生—内分泌]