胰岛素治疗血糖控制不佳的2型糖尿病患者联合达格列净的疗效及安全性(1)
[摘要] 目的 探讨胰岛素治疗血糖控制不佳的2型糖尿病患者联合SGLT-2抑制剂的疗效和安全性。 方法 选取于2017年5—7月该院收治的60例糖化血红蛋白(HbA1c)≥9.0%的2型糖尿病患者随机分为联合组(n=32)和胰岛素组(n=28)，观察治疗12周前后空腹血糖(FPG)、餐后血糖(PPG)、糖化血红蛋白(HbA1c)、体重指数(BMI)、尿酸(UA)以及血压(BP)、血脂变化，比较两组胰岛素日用量、达标时间(Time)和低血糖发生次数(n)等其他不良反应情况。 结果 两组心肺肝肾功能无明显异常。两组HbA1c较治疗前明显下降(P<0.05)，联合组在FPG、BMI、UA、TG、LDL-C、SBP、DBP，低血糖次数皆明显低于胰岛素组(P<0.05)，血糖达标时间、胰岛素日用量显著降低(P<0.01)。 结论 胰岛素联合SGLT-2抑制剂，效果明显优于单纯胰岛素治疗。且中心性肥胖、血压，血脂及尿酸得以改善，胰岛素日计量及低血糖反应减少，并可能有降糖之外的心血管获益，值得临床推广。
[关键词] 2型糖尿病；钠-葡萄糖协同转运蛋白2(SGLT-2)抑制剂；胰岛素
[中图分类号] R587.1 [文献标识码] A [文章编号] 1672-4062(2017)11(b)-0064-03
[Abstract] Objective To study the curative effect and safety of insulin combined with SGLT-2 inhibitor in treatment of type 2 diabetes patients with bad blood glucose control. Methods 60 cases of type 2 diabetes patients whose (HbA1c)≥9.0% from our hospital which selected from May to July 2017 were randomly divided into two groups， including the combined group (n=32)and insulin group (n=28)， and the FPG， PPG， HbA1c， BMI， UA， BP and blood liquid changes in 12 weeks before and after treatment were observed， and the daily dose of insulin， standards-reaching time and occurrence frequency of hypoglycemia and other adverse reactions were compared between the two groups. Results There were no obvious abnormalities in the cardiopulmonary liver and kidney function， and the HbA1c of the two groups obviously decreased compared with that before treatment(P<0.05)， and the FPG， BMI， UA， TG， LDL-C， SBP， DBP， hypoglycemia frequency in the combined group were obviously lower than those in the insulin group(P<0.05)， and the blood glucose standards-reaching time and daily dosage of insulin obviously decreased(P<0.05). Conclusion The effect of insulin combined with SGLT-2 inhibitor is obviously better than that of single insulin therapy， which can improve the central obesity， blood pressure， blood liquid and uric acid and reduce the daily dose of insulin and hyporglycemia reactions， and it may benefit the cardiovascular organs， and it is worth clinical promotion.
[Key words] Type 2 diabetes； SGLT-2 inhibitor； Insulin
2014年全球确诊糖尿病患者共3.87亿例，患病率8.3%[1]。2010年中国慢病监测暨糖尿病专题调查显示，中国成人糖尿病患病率为11.6%(约1.139亿例)，男性和女性分别为12.1%和11.0%[2]。但目前糖尿病药物仅能使53%的患者达到HbA1c<7.0%[3]。在中国，仅有25.8%的糖尿病患者已接受或正在接受降糖药物治疗，而其中只有39.7%的患者血糖控制良好[2]。2型糖尿病(T2DM)患者体内高胰岛素血症及胰岛素抵抗并存，并常合并有高血壓，高脂血症，脂肪肝，高尿酸血症及冠心病等代谢综合征表现。由于胰岛素敏感性降低，导致胰岛素的使用剂量偏大而治疗效果不理想。该研究于2017年5—7月选取60例患者对血糖控制不佳的T2DM患者在预混胰岛素基础上加服SGLT-2抑制剂，探讨达格列净联合胰岛素治疗方案的疗效和安全性。
1 资料与方法, http://www.100md.com(陈晓蕾 贾农 杨林 蔡丽萍 夏连丽 杨锐林 宋琳)
[关键词] 2型糖尿病；钠-葡萄糖协同转运蛋白2(SGLT-2)抑制剂；胰岛素
[中图分类号] R587.1 [文献标识码] A [文章编号] 1672-4062(2017)11(b)-0064-03
[Abstract] Objective To study the curative effect and safety of insulin combined with SGLT-2 inhibitor in treatment of type 2 diabetes patients with bad blood glucose control. Methods 60 cases of type 2 diabetes patients whose (HbA1c)≥9.0% from our hospital which selected from May to July 2017 were randomly divided into two groups， including the combined group (n=32)and insulin group (n=28)， and the FPG， PPG， HbA1c， BMI， UA， BP and blood liquid changes in 12 weeks before and after treatment were observed， and the daily dose of insulin， standards-reaching time and occurrence frequency of hypoglycemia and other adverse reactions were compared between the two groups. Results There were no obvious abnormalities in the cardiopulmonary liver and kidney function， and the HbA1c of the two groups obviously decreased compared with that before treatment(P<0.05)， and the FPG， BMI， UA， TG， LDL-C， SBP， DBP， hypoglycemia frequency in the combined group were obviously lower than those in the insulin group(P<0.05)， and the blood glucose standards-reaching time and daily dosage of insulin obviously decreased(P<0.05). Conclusion The effect of insulin combined with SGLT-2 inhibitor is obviously better than that of single insulin therapy， which can improve the central obesity， blood pressure， blood liquid and uric acid and reduce the daily dose of insulin and hyporglycemia reactions， and it may benefit the cardiovascular organs， and it is worth clinical promotion.
[Key words] Type 2 diabetes； SGLT-2 inhibitor； Insulin
2014年全球确诊糖尿病患者共3.87亿例，患病率8.3%[1]。2010年中国慢病监测暨糖尿病专题调查显示，中国成人糖尿病患病率为11.6%(约1.139亿例)，男性和女性分别为12.1%和11.0%[2]。但目前糖尿病药物仅能使53%的患者达到HbA1c<7.0%[3]。在中国，仅有25.8%的糖尿病患者已接受或正在接受降糖药物治疗，而其中只有39.7%的患者血糖控制良好[2]。2型糖尿病(T2DM)患者体内高胰岛素血症及胰岛素抵抗并存，并常合并有高血壓，高脂血症，脂肪肝，高尿酸血症及冠心病等代谢综合征表现。由于胰岛素敏感性降低，导致胰岛素的使用剂量偏大而治疗效果不理想。该研究于2017年5—7月选取60例患者对血糖控制不佳的T2DM患者在预混胰岛素基础上加服SGLT-2抑制剂，探讨达格列净联合胰岛素治疗方案的疗效和安全性。
1 资料与方法, http://www.100md.com(陈晓蕾 贾农 杨林 蔡丽萍 夏连丽 杨锐林 宋琳)