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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、2h C-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,差异具有统计学意义(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。
Objective To investigate the clinical efficacy and safety of combination of insulin glargine, glimepiride and pioglitazone in newly diagnosed type 2 diabetes mellitus (T2DM). Methods A total of 120 newly diagnosed type 2 diabetic patients were randomly divided into group A (glargine plus glimepiride), group B (insulin glargine combined with pioglitazone) and group C (insulin glargine, glimepiride, pioglitazone Three drugs combined treatment), 40 cases in each group. Were given short-term intensive treatment for 12 weeks. The fasting blood glucose (FPG), postprandial blood glucose (2 hPG), fasting C-peptide (FC-P) and 2 hC-P, HbA1c Quality Index (BMI), Insulin Resistance Index (HOMA-IR), fasting blood glucose compliance time, daily insulin dosage, and incidence of hypoglycemia. Results Compared with those before treatment, the levels of FPG, 2 hPG, HbA1c and HOMA-IR in three groups after treatment were significantly decreased, while the levels of FC-P and 2 hC-P were significantly increased (P <0.05). Three groups of patients before and after treatment BMI was no significant difference (P> 0.05). There was no significant difference in FPG, 2hPG, HbA1c, HOMA-IR, FC-P, 2h C-P and BMI between the three groups after treatment (P> 0.05). The incidence of hypoglycemia in group C was 2.5%, lower than 15.0% in group A and 17.5% in group B, the difference was statistically significant (P <0.05). The fasting blood glucose in C group was shorter than that in A and B groups, and the dosage of insulin was less than that in A and B groups. The difference was statistically significant (P <0.05). Conclusion Glargine combined with glimepiride and pioglitazone can be good control of newly diagnosed type 2 diabetes patients with blood glucose, reduce insulin resistance, low incidence of hypoglycemia, it is worth clinical promotion.