二甲双胍联合吡格列酮或西格列汀在2型糖尿病肥胖患者二甲双胍疗效不佳病例中的应用  

Effect of Metformin Combined with Pioglitazone or Sitagliptin in Cases of Poor Metformin Response in Obese Patients with Type 2 Diabetes Mellitus

作　　者：朱丽晔 ZHU Liye(Department of Endocrinology,Nanjing Lishui People's Hospital,Nanjing 211200,Jiangsu,China)

机构地区：[1]南京市溧水区人民医院内分泌科,江苏南京211200

出　　处：《糖尿病新世界》2024年第17期89-92,共4页Diabetes New World

摘　　要：目的探讨二甲双胍联合吡格列酮或西格列汀两种用药方案在肥胖型2型糖尿病患者中的应用价值。方法选取2022年1月—2023年12月南京市溧水区人民医院内分泌科收治的80例2型糖尿病患者为研究对象,按照治疗方法的不同分为两组,每组40例。A组采用二甲双胍与吡格列酮联合用药方案,B组采用二甲双胍与西格列汀联合用药方案。比较两组体重指数(body mass index,BMI)、空腹胰岛素(fasting insulin,FINS),空腹血糖(fasting plasma glucose,FPG)和餐后2 h血糖(2-hour postprandial plasma glucose,2 hPG)、胰岛素敏感指数(homeostatic model assessment of insulin sensitivity,HOMA-IS)、胰岛β细胞功能指数(homeostatic model assessment of insulin-βcell,HOMA-β)和胰岛素抵抗指数(homeostatic model assessment of insulin resistance,HOMA-IR)以及不良反应发生情况。结果治疗前,两组FPG、FINS、BMI和2 hPG水平比较,差异无统计学意义(P均>0.05)。治疗后,两组FINS水平比较,差异无统计学意义(P>0.05),B组BMI、2 hPG均低于A组,FPG高于A组,差异有统计学意义(P均<0.05)。治疗前,两组HOMA-IS、HOMA-β和HOMA-IR比较,差异无统计学意义(P>0.05)。治疗后,两组HOMA-IS、HOMA-β和HOMA-IR均优于治疗前,且B组HOMA-β低于A组,差异有统计学意义(P均<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论两种联合用药方案均能够有效调节二甲双胍疗单药疗效不佳的肥胖型2型糖尿病患者的胰岛素水平且较为安全,在改善餐后血糖、BMI效果方面,西格列汀优于吡格列酮;在改善FPG方面,吡格列酮优于西格列汀。Objective To explore the application value of metformin combined with pioglitazone or sitagliptin in obese patients with type 2 diabetes mellitus.Methods A total of 80 patients with type 2 diabetes mellitus treated in the Department of Endocrinology of Nanjing Lishui People's Hospital from January 2022 to December 2023 were selected as the study objects and divided into two groups according to different treatment methods,with 40 cases in each group.Group A was treated with metformin combined with pioglitazone,and group B was treated with metformin combined with sitagliptin.Body mass index(BMI),fasting insulin(FINS),fasting plasma glucose(FPG),2-hour postprandial plasma glucose(2 hPG),homeostatic model assessment of insulin sensitivity(HOMA-IS),homeostatic model assessment of insulin-βcell(HOMA-β),homeostatic model assessment of insulin resistance(HOMA-IR)and adverse reactions were compared between the two groups.Results Before treatment,there were no significant differences in the levels of FPG,FINS,BMI and 2 hPG between the two groups(all P>0.05).After treatment,there was no significant difference in FINS level between the two groups(P>0.05).BMI and 2 hPG in group B were lower than those in group A,FPG was higher than that in group A,and the differences were statistically significant(all P<0.05).Before treatment,there were no significant differences in HOMA-IS,HOMA-βand HOMA-IR between the two groups(all P>0.05).After treatment,HOMA-IS,HOMA-βand HOMA-IR in the two groups were better than those before treatment,and HOMA-βin group B was lower than that in group A,the differences were statistically significant(all P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The two combination regimens can effectively regulate the insulin level of obese type 2 diabetic patients with poor efficacy of metformin monotherapy and are relatively safe.Sitagliptin is superior to pioglitazone in improving postprandial blood glucose and BMI,and pioglitazone

关 键 词：吡格列酮 西格列汀 肥胖型2型糖尿病 二甲双胍 

分 类 号：R587.1[医药卫生—内分泌]