艾塞那肽与预混胰岛素治疗新诊断2型糖尿病患者临床疗效和安全性比较  

Comparison of Exenatide with premixed insulin on efficacy and safety in patients with newly diagnosed type 2 diabetes mellitus

作　　者：叶景璐[1] 钟兴[1] 杜益君[1] 潘天荣[1] 

机构地区：[1]安徽医科大学第二附属医院内分泌科,合肥230601

出　　处：《中国糖尿病杂志》2017年第9期817-821,共5页Chinese Journal of Diabetes

摘　　要：目的探讨新诊断T2DM患者胰岛素强化治疗后艾塞那肽或预混胰岛素序贯治疗的临床疗效和安全性比较。方法选取2014年1月至2015年12月于我院住院的新诊断T2DM患者132例,随机分为3组,入院后予胰岛素强化治疗,血糖控制平稳后予艾塞那肽联合甘精胰岛素治疗(艾塞那肽+甘精胰岛素组,n=48),艾塞那肽联合二甲双胍治疗(艾塞那肽+二甲双胍组,n=32)及预混胰岛素治疗(预混胰岛素组,n=52)。观察12周,比较治疗前后FPG、2hPG、HbA_1c、FC-P、BMI、胰岛素抵抗指数(HOMA-IR)、胰岛β细胞分泌指数(HOMA-β)及低血糖和消化道不良反应发生率。结果治疗12周后各组FPG、HbA_1c和HOMA-IR较治疗前降低(P<0.05),HOMA-β较治疗前升高[(42.28±29.10)vs(117.05±64.39),(39.81±21.52)vs(116.00±56.28),(44.25±31.80)vs(112.79±41.78),P<0.05],治疗后各组间比较,差异无统计学意义(F=0.502、0.315、1.620、0.062、0.271,P>0.05);治疗后预混胰岛素组体重、BMI高于艾塞那肽+甘精胰岛素组和艾塞那肽+二甲双胍组(F=3.246、11.449,P<0.05);艾塞那肽+二甲双胍组低血糖发生率低于预混胰岛素组(3.13%vs 21.15%)(χ~2=5.258,P<0.05);预混胰岛素组消化道不良反应发生率低于艾塞那肽+甘精胰岛素组和艾塞那肽+二甲双胍组[(0.00%vs 20.83%),(0.00%vs 25.00%)],(χ~2=12.037、14.368,P<0.01)。结论新诊断T2DM患者胰岛素强化治疗后选择艾塞那肽联合二甲双胍或基础胰岛素治疗,其降糖效果不劣于预混胰岛素,但体重控制更佳,低血糖发生率更低。Objective To compare the efficacy and Safety between Exenatide and premixed insulin after intensive insulin therapy in newly diagnosed type 2 diabetes mellitus（T2DM）. Methods A total of 132 hospitalized patients with newly diagnosed T2DM in the second hospital of Anhui Medical University from Jan 2014 to Dec 2015 were recruited. These patients were divided into 3 groups randomly as follows： Exenatide combined with insulin glargine treatment （n = 48 ）, Exenatide combined with Metformin treatment（n= 32） and Premixed insulin treatment（n = 52）. All patients were given intensive insulin therapy since admission, then they received treatments mentioned above when blood glucose values were well controlled. The observation time lasted for 12 weeks. FPG, 2 hPG, HbA1c, FC-P, BMI, homeostasis model assessment for insulin resistance（HOMA-IR）, homeostasis model assessment for beta cell function （HOMA-β） were detected at baseline and at the end of observation. In addition, incidence rate of hypoglycemia and gastrointestinal adverse reaction were evaluated. Results After 12 weeks of treatment, FPG, 2 hPG and HbA1c of the three groups were significantly decreased（P〈0. 05） ; HOMA-β [（42.28±29.10） vs （117.05 ± 64.39）, （39.81± 21.52） vs （116.00±56.28）,（44.25±31.80） vs （112. 79 ± 41.78）, P〈 0. 05] was obviously increased; HOMA-IR was significantly decreased after treatment. There were no statistical differences among the three groups after treatment（F= 0. 502,0. 315, 1. 620,0. 062 and 0. 271, P〉0.05）. Body weight and BMI of Premixecl insulin group were higher than the other two groups（F= 3. 246,11. 449, P〈0.05）. Incidence rate of hypoglycemia of Exenatide combined with Metformin group was lower than that of Premixed insulin group（3.13% vs 21.15%）（Х^2= 5. 258,P 〈0.05）. Incidence rate of gastrointestinal reaction was lower in premixed insulin group than the other two groups（0.00% vs 20.83%,0.00% vs 25.00%）,（Х^2=12.037, 14.368,P〈0.01）. Co

关 键 词：艾塞那肽 胰岛素 糖尿病 2型 

分 类 号：R587.1[医药卫生—内分泌]