达格列净联合胰岛素对脆性糖尿病血糖波动影响的观察研究  

Changes in blood glycemic variations in fragile diabetics treated with intensive insulin therapy combined with dapagliflozin

作　　者：丁大法[1] 万丽丽 张琳琳 高玮 王绘 Ding Dafa,Wan Lili,Zhang Linlin,Gao Wei,Wang Hui(Department of Endocrinology,the Affiliated Second Hospital, Nanjin Medical University, Nanjin 210011,China)

机构地区：[1]南京医科大学第二附属医院内分泌科,210011 [2]江苏省盐城市亭湖区人民医院内分泌科

出　　处：《中华内分泌代谢杂志》2018年第10期844-847,共4页Chinese Journal of Endocrinology and Metabolism

基　　金：江苏省科技厅省社发面上项目（BE2016800）

摘　　要：在胰岛素强化治疗后，血糖仍控制不佳的20例脆性糖尿病患者联合应用达格列净治疗，随访12周后记录患者的血糖控制情况、胰岛素剂量变化，检测8-异前列腺素F2α（8-PGF2α）、超敏C-反应蛋白（hs-CRP）的变化及安全性指标。结果显示，经过12周的随访，患者的HbA1c、空腹血糖、餐后2h血糖、四分位血糖波动范围（IQR）、血糖水平标准差（SDBG）、最大血糖波动幅度（LAGE）、餐后血糖波动幅度（PPGE）、日间血糖平均绝对差（MODD）都较治疗前明显下降（均P〈0．01）；与治疗前比较，8-PGF2α、hs-CRP明显下降，胰岛素用量明显减少（P〈0．01）；治疗后患者的体重有程度不等的下降（P〈0．05），低血糖情况明显改善，未见严重低血糖报告。提示在胰岛素强化治疗的基础上联合应用达格列净治疗脆性糖尿病，患者糖代谢明显改善、胰岛素用量减少、低血糖事件减少。Twenty inadequately controlled diabetic patients treated with insulin therapy received dapagliflozin treatment for 12 weeks. HbA1c, glycemic variations, plasma 8-iso-prostaglandin F2α （8-PGF2α）, and hypersensitive C-reactive protein （hs-CRP） levels, the change of the insulin dose, and the safety of treatments were analyzed. The results showed that after 12-week dapagliflozin therapy, HbA1c, fasting plasma glucose, postprandial 2h plasma glucose, inter-quartile range, standard deviation of blood glucose, large amplitude glyeemic excursions, postprandial glucose excursion, as well as absolute means of daily difference were significantly decreased （ P 〈 0.01 ）. Compared with those before treatment, addition of dapagliflozin notably decreased plasma 8-PGF2α and hs-CPR levels, along with reduced insulin dosage （ P 〈 0. 01 ） and decreased body weight of patients （ P 〈 0.05 ）. After dapagliflozin treatment, the hypoglycemia of the patients was obviously improved, without report of severe hypoglycemia. These results indicate that dapagliflozin treatement improves glucose metabolism, and reduces insulin dosage and the hypoglycemic events in fragile diabetics with intensive insulin therapy.

关 键 词：脆性糖尿病 钠-葡萄糖转运蛋白2抑制剂 胰岛素 治疗 

分 类 号：R587.1[医药卫生—内分泌]