三种序贯降糖方案在超重/肥胖2型糖尿病短期强化降糖后应用的有效性和安全性对比  

Comparison of efficacy and safety of three sequential hypoglycemic regimens in overweight/obese type 2 diabetes mellitus after short-term intensive hypoglycemic therapy

作　　者：席巍 姚丽君 汪琳姣 XI Wei;YAO Li-jun;WANG Lin-jiao(Department of Endocrinology,Hai′an People′s Hospital,Jiangsu Province,Hai′an 226600,China)

机构地区：[1]江苏省海安市人民医院内分泌科,江苏海安226600

出　　处：《河北医科大学学报》2023年第11期1279-1284,共6页Journal of Hebei Medical University

基　　金：江苏省卫生健康委科研立项(Z2019033);江苏省南通市科技局项目(MSZ2022057)。

摘　　要：目的探究三种序贯降糖方案在超重/肥胖2型糖尿病(type 2 diabetes,T2DM)短期强化降糖后应用的有效性和安全性对比。方法选取海安市人民医院内分泌科收治的99例超重/肥胖T2DM患者,所有患者均进行短期胰岛素泵强化治疗(continuous subcutaneous insulin infusion,CSII),强化降糖后进行序贯降糖,根据序贯降糖方案的不同分为3组,各33例。A组给予格列美脲+二甲双胍,B组给予度拉糖肽1.5 mg,1次/周,皮下注射+二甲双胍,C组给予门冬胰岛素30+二甲双胍,总疗程为12周。测量治疗12周后的体重、血糖及C肽水平,统计患者12周内服药依从情况及低血糖症发生情况。结果治疗后,A组体重指数(body mass index,BMI)升高,B组BMI、腰臀比均降低,C组BMI、腰臀比均升高(P<0.05);B组BMI、腰臀比均低于A组、C组(P<0.05);治疗后,3组空腹血糖(fasting blood glucose,FBG)、糖化血红和蛋白(glycosylated hemoglobin,HbA_(1)c)水平降低(P<0.05),A、B组治疗后的FBG水平高于C组(P<0.05),3组治疗后的HbA 1c水平及HbA_(1)c达标率比较,差异无统计学意义(P>0.05);治疗后,B组空腹C肽(fasting c-peptide,F-CP)水平降低、餐后2 hC肽水平升高(P<0.05),B组F-CP水平低于A、C组,B组餐后2 h C肽(postprandial 2 h C Peptide,2 hP-CP)水平高于A、C组(P<0.05);A、B、C 3组的治疗总依从率分别为70.97%(22/31),96.77%(30/31),83.87%(26/31),其中A组服药总依从率低于B组(P<0.05);A、B、C 3组T2DM患者序贯治疗期间低血糖症发生率分别为19.35%(6/31)、9.68%(3/31),48.39%(15/31),A、B组低血糖症发生率低于C组(P<0.05)。结论3种序贯降糖方案比较,度拉糖肽联合二甲双胍在超重/肥胖T2DM短期强化降糖后对于体重、血糖控制及胰岛B细胞功能改善方面具有明显优势,且该方案在治疗期间治疗依从性较高,低血糖症发生率较低,具有更高的有效性、安全性。Objective To explore the efficacy and safety of three sequential hypoglycemic regimens in overweight/obese type 2 diabetes mellitus(T2DM)after short-term intensive hypoglycemic therapy.Methods A total of 99 overweight/obese T2DM patients admitted to the Department of Endocrinology of Hai′an People′s Hospital were selected.All patients were treated with continuous subcutaneous insulin infusion(CSII),followed by sequential hypoglycemic therapy after intensive hypoglycemic therapy.They were divided into three groups according to different sequential hypoglycemic regimens,with 33 cases in each group.Group A was given glimepiride+metformin,group B was given subcutaneous injection of dulaglutide 1.5 mg(once a week)+metformin,and group C was given insulin aspart 30+metformin for a total course of 12 weeks.The body weight,blood glucose and C-peptide levels at 12 weeks after treatment were measured,and the patients′medication compliance and hypoglycemia within 1 year were calculated.Results After treatment,body mass index(BMI)in group A was increased,BMI,and waist to hip ratio(WHR)in group B were decreased,and BMI and WHR in group C were increased(P<0.05).BMI and WHR in group B were lower than those in groups A and C(P<0.05).The levels of fasting blood glucose(FBG)and glycosylated hemoglobin(HbA_(1)c)in the three groups were decreased after treatment(P<0.05),and the levels of FBG in groups A and B after treatment were higher than those in group C(P<0.05).There was no significant difference in HbA_(1)c level and HbA 1c compliance rate among the three groups after treatment(P>0.05).The level of fasting c-peptide(F-CP)was decreased and the level of postprandial 2 h C peptide(2 h P-CP)was increased in group B after treatment(P<0.05).The level of F-CP in group B was lower than that in groups A and C,while the level of 2 hP-CP in group B was higher than that in groups B and C(P<0.05).The total compliance rates of patients in groups A,B and C were 70.97%(22/31),96.77%(30/31)and 83.87%(26/31),respectively.The total complian

关 键 词：糖尿病 2型 超重 肥胖症 胰岛素分泌细胞 

分 类 号：R587.1[医药卫生—内分泌]