单用二甲双胍控制不佳的2型糖尿病患者联用达格列净或格列美脲的临床研究  

A clinical study of combined use of dapagliflozin or glimepiride in poorly controlled type 2 diabetic patients treated with metformin alone

作　　者：陈光明[1] 王姗姗[2] 王华斌[3] CHEN Guangming;WANG Shanshan;WANG Huabin(Department of General Medicine,Jinhua Central Hospital in Zhejiang Province,Jinhua 321000,China;Department of Endocrinology and Metabolism,Jinhua Central Hospital in Zhejiang Province,Jinhua 321000,China;Department of Laboratory,Jinhua Central Hospital in Zhejiang Province,Jinhua 321000,China)

机构地区：[1]浙江省金华市中心医院全科医学科,浙江金华321000 [2]浙江省金华市中心医院内分泌代谢科,浙江金华321000 [3]浙江省金华市中心医院检验科,浙江金华321000

出　　处：《中国现代医生》2021年第10期23-26,共4页China Modern Doctor

基　　金：浙江省科学技术厅项目(2017C33206)。

摘　　要：目的评估达格列净或格列美脲在单用二甲双胍血糖控制不佳的2型糖尿病患者中的临床疗效及安全性。方法收集2018年5月~2019年5月在我院门诊和病房就诊的单用二甲双胍血糖控制仍不达标的2型糖尿病患者60例,随机分成对照组和试验组各30例。两组均保持原来二甲双胍剂量和用法不变,对照组加用格列美脲,试验组加用达格列净口服,持续治疗12周。比较两组治疗前后腰围、体重、血压、血糖水平及胰岛β细胞功能改善情况。结果(1)治疗后试验组腰围、体重显著低于对照组,差异有统计学意义(P<0.05)。(2)治疗后两组FBG、2 hPG、HbA1c较治疗前明显下降,差异有统计学意义(P<0.05),但组间差异无统计学意义(P>0.05)。(3)治疗后试验组FINS、HOMA-β高于对照组,HOMA-IR低于对照组,差异有统计学意义(P<0.05)。(4)治疗期间两组均无严重不良反应,试验组轻度低血糖发生率低于对照组,差异有统计学意义(P<0.05)。结论单用二甲双胍血糖控制不佳的患者联用达格列净或格列美脲均可显著降低血糖水平,达格列净能够更有效的缩小腰围、减轻体重及改善胰岛β细胞功能,且低血糖发生率更低,安全性高,值得临床推广应用。Objective To evaluate the clinical efficacy and safety of dapagliflozin or glimepiride in poorly controlled type 2 diabetic patients treated with metformin alone.Methods A total of 60 patients with type 2 diabetes who received metformin alone but still failed to meet the blood glucose control standards from May 2018 to May 2019 were randomly divided into two groups,with 30 patients in the control group and 30 patients in the experimental group.The dosage and administration of metformin were kept unchanged in both groups.The control group was given glimepiride,and the experimental group was given dapagliflozin oral administration.The treatment lasted for 12 weeks.Waist circumference,body weight,blood pressure,blood glucose level,and the improvement of islet cell function were compared between the two groups before and after treatment.Results After treatment,waist circumference and body weight in the experimental group were significantly lower than those in the control group,with a statistically significant difference(P<0.05).(2)FBG,2 hPG,and HbA1c were significantly decreased in the two groups after treatment compared with before treatment,and the difference was statistically significant(P<0.05).But there was no statistically significant difference between the two groups(P>0.05).(3)After treatment,FINS and HOMA-βin the experimental group were higher than those in the control group,while HOMA-IR was lower than that in the control group,and the difference was statistically significant(P<0.05).(4)There were no severe adverse reactions in the two groups during the treatment.The incidence of mild hypoglycemia in the experimental group was lower than that in the control group,and the difference between the two groups was statistically significant(P<0.05).Conclusion In patients with poor glycemic control with metformin alone,the combination of dapagliflozin or glimepiride can significantly reduce blood glucose levels.Dapagliflozin is more effective in reducing waist circumference,reducing body weight,and improving islet

关 键 词：2型糖尿病 二甲双胍 达格列净 格列美脲 空腹血糖 

分 类 号：R587.1[医药卫生—内分泌]