甘精胰岛素、格列美脲、吡格列酮三药联合 治疗初诊2型糖尿病的疗效及安全性评价

甘精胰岛素、格列美脲、吡格列酮三药联合治疗初诊2型糖尿病的

疗效及安全性评价

摘要目的探讨甘精胰岛素、格列美脲、吡格列酮三药联合治疗初诊2型糖尿病（T2DM）的临床疗效和安全性。方法120例初诊2型糖尿病患者，随机分为A组（甘精胰岛素联合格列美脲治疗）、B组（甘精胰岛素联合吡格列酮治疗）和C组（甘精胰岛素、格列美脲、吡格列酮三药联合治疗），每组40例。分别给予短期强化治疗12周。比较治疗前后三组患者的空腹（FPG）、餐后2 h 血糖（2 hPG）、空腹C肽（FC-P）及餐后2 hC肽（2 hC-P）、糖化血红蛋白（HbA1c）、体质量指数（BMI）、胰岛素抵抗指数（HOMA-IR）、空腹血糖达标时间、胰岛素日用量以及低血糖发生率。结果与治疗前比较，治疗后三组患者FPG、2 hPG、HbA1c及HOMA-IR均显著下降，FC-P、2 hC-P均显著升高，差异具有统计学意义（P＜0.05）。三组患者BMI治疗前后比较差异无统计学意义（P>0.05）。治疗后三组FPG、2hPG、HbA1c、HOMA-IR、FC-P、2hC-P及BMI比较差异无统计学意义（P>0.05）。C组低血糖发生率为2.5%，低于A组的15.0%、B组的17.5%，差异具有统计学意义（P＜0.05）。C组空腹血糖达标时间短于A、B组，胰岛素用量少于A、B组，差异具有统計学意义（P＜0.05）。结论甘精胰岛素联合格列美脲和吡格列酮能很好的控制初诊2型糖尿病患者的血糖，降低胰岛素抵抗，低血糖发生率低，值得临床推广。

关键词初诊2型糖尿病；甘精胰岛素；格列美脲；吡格列酮

Evaluation of curative effect and safety by insulin glargine，glimepiride and pioglitazone in combined treatment of newly diagnosed type 2 diabetes mellitus XIA Mei-na，CHEN Wen-juan，WEI Jin，et al. Department of Health Care Endocrinology，Shandong Changyi City People’s Hospital，Changyi 261300，China

【Abstract】Objective To investigate clinical effect and safety by insulin glargine，glimepiride and pioglitazone in combined treatment of newly diagnosed type 2 diabetes mellitus （T2DM）. Methods A total of 120 patients with newly diagnosed type 2 diabetes mellitus were randomly divided into group A （insulin glargine combined with glimepiride for treatment），group B （insulin glargine combined with pioglitazone for treamtent）and group C （insulin glargine combined with glimepiride and pioglitazone for treatment），with 40 cases in each group. Their short-term intensive treatment all lasted for 12 weeks. Comparison was made on fasting plasma glucose （FPG），2 h postprandial blood glucose （2 h PG），fasting C-peptide （FC-P）， 2 h postprandial C-peptide （2 h C-P），glycosylated hemoglobin （HbA1c），body mass index （BMI），homeostasis model assessment-insulin resistance index （HOMA-IR），fasting plasma glucose standard time，daily dosage of insulin and incidence of hypoglycemia across the three groups before and after treatment. Results Comparing with those before treatment，all three

groups had obviously lower FPG，2 h PG，HbA1c，HOMA-IR and higher FC-P and 2 h C-P after treatment，and their difference had statistical significance （P＜0.05）. There was no statistically significant difference of BMI before and after treatment across the three groups （P>0.05）. After treatment，the difference of FPG，2 h PG，HbA1c，HOMA-IR FC-P，2 h C-P and BMI had no statistical significance in the three groups （P>0.05）. Group C had lower incidence of hypoglycemia as 2.5% than 15.0% in group A and 17.5% in group B，and their difference had statistical significance （P＜0.05）. Group C had shorter fasting plasma glucose standard time and less daily dosage of insulin than groups A and B，and their difference had statistical significance （P＜0.05）. Conclusion Combination of insulin glargine，glimepiride and pioglitazone provides good blood glucose control in newly diagnosed type 2 diabetes mellitus patients，along with decreased insulin resistance and incidence of hypoglycemia. This method is worth clinical promotion.【Key words】Newly diagnosed type 2 diabetes mellitus；Insulin glargine；Glimepiride；Pioglitazone

2型糖尿病是以胰岛素抵抗和β细胞功能缺陷为理特征的疾病，患者血糖水平高，产生糖毒性和脂毒性，使β细胞功能衰退。因此，在病程早期进行胰岛素治疗，可降低胰岛素抵抗，减少糖毒性和脂毒性，使β细胞功能得到恢复，甚至使患者回到更早期阶段，仅靠饮食控制和运动即可良好的控制血糖[1-4]。本试验采用甘精胰岛素联合格列美脲和吡格列酮对患者进行短期强化治疗，探讨联合给药的疗效和安全性，现报告如下。

1 资料与方法

1. 1 一般资料按照1999年WHO的糖尿病诊断标准，选取2011年10月～2013年12月本院收治的初诊2型糖尿病患者（HbA1c>9%）120例，其中男63例，女57例，年龄36～68岁，

平均年龄（50.32±6.74）岁，排除标准：严重感染，1型糖尿病，严重心、肺、肝、肾、胃肠疾病患者，妊娠及哺乳期妇女。将120例患者随机分为A、B、C组，各40例。A组男22例，女18例，年龄36～65岁，平均年龄（49.24±5.28）岁；B组男17例，

女23例，年龄38～68岁，平均年龄（51.79±5.44）岁；C组男24例，女16例，年龄36～67岁，平均年龄（49.98±5.68）岁。

三组患者性别、年龄等一般资料比较差异无统计学意义（P>0.05），具有可比性。

1. 2 治疗方法A组患者给予甘精胰岛素+格列美脲治疗；B组患者给予甘精胰岛素+吡格列酮治疗；C组患者给予甘精胰岛素+格列美脲+吡格列酮治疗。治疗期间有医生根据血糖制定饮食运动方案，每周回访。治疗周期为12周。药物用法用量：甘精胰岛素（来得时，规格：300 IU）睡前皮下注射，初始剂量0.2