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目的:观察降糖通络汤对2型糖尿病(type 2 diabetes,T2DM)患者血糖波动的影响。方法:将90例T2 DM患者采用随机数字法分为对照组和观察组各45例。对照组采用阿卡波糖片及重组甘精胰岛素注射液以控制血糖。观察组在对照组治疗基础上加用降糖通络汤,1剂·d-1。两组疗程均为12周。采用动态血糖监测系统监测血糖水平的标准差(standard deviation,SDBG)、日内平均血糖波动幅度(mean amplitude of glycemic excursions,MAGE)、日内血糖极差(Largest amplitude of glycemic excursions,LAGE)、日间血糖平均绝对差(absolute means of daily differences,MODD)及餐后血糖波动均值(mean of postprandial glucose excursion,MPPGE),检测空腹血糖(Fasting blood-glucose,FBG)、餐后2小时血糖(postprandial blood glucose 2 hour,2h PBG)、糖化血红蛋白(glycosylated hemoglobin,Hb Alc)及空腹胰岛素(fasting insulin,FINS),并计算胰岛素抵抗指数(homeostasis model assessment,HOMA-IR)、胰岛β细胞分泌功能指数(homa beta cell function index,HOMA-β)和胰岛素敏感指数(Insulin sensitive index,ISI),治疗前后各评价1次。结果:观察组治疗后SDBG、MAGE、LAGE、MODD及MPPGE水平分别为(1.07±0.53)mmol·L-1、(1.13±0.47)mmol·L-1、(4.69±0.75)mmol·L-1、(1.51±0.23)mmol·L-1及(3.05±0.63)mmol·L-1,均显著低于对照组的(1.62±0.55)mmol·L-1、(2.15±0.43)mmol·L-1、(5.53±0.81)mmol·L-1、(1.83±0.21)mmol·L-1及(3.87±0.75)mmol·L-1(P<0.01);治疗后观察组2h PG、Hb A1c及FINS水平分别为(8.59±1.28)mmol·L-1、(6.83±0.76)%及(7.06±0.88)m U·L-1,均显著低于对照组的(9.16±1.77)mmol·L-1、(7.68±0.79)%及(9.75±0.93)m U·L-1(P<0.05或P<0.01);治疗后两组HOMA-IR水平下降,治疗后观察组HOMA-IR水平为(1.67±0.45)低于对照组的(2.18±0.53)(P<0.01);治疗后两组HOMA-β和ISI较治疗前上升(P<0.01),观察组HOMA-β和ISI水平为(67.5±7.17)和(-2.75±0.31),均高于对照组的(60.6±6.93)和(-3.31±0.24)(P<0.01)。结论:降糖通络汤能降低T2DM患者2h PG和Hb A1c水平,调节日内血糖波动、稳定血糖,其作用机制可能是通过改善β细胞分泌功能,从而提高机体胰岛素敏感性。
Objective: To observe the effect of Jiangtangtongluo decoction on blood glucose in type 2 diabetes (T2DM) patients. Methods: 90 cases of T2 DM patients were divided into control group and observation group by random number method in 45 cases. Control group using acarbose and recombinant insulin glargine injection to control blood sugar. Observation group in the control group based on the use of Jiangtang Tongluo Decoction, 1 d · 1. The two groups were treated for 12 weeks. A dynamic glucose monitoring system was used to monitor the standard deviation (SDBG), mean amplitude of glycemic excursions (MAGE), the daily amplitude of glycemic excursions (LAGE), blood glucose The average absolute difference of daily differences (MODD) and mean postprandial glucose excursion (MPPGE) were measured. Fasting blood glucose (FBG), postprandial blood glucose 2 hour, 2h PBG, Hb Alc and fasting insulin (FINS) were measured. The levels of homeostasis model assessment (HOMA-IR), homa beta cell function index, HOMA-β) and Insulin sensitive index (ISI) were evaluated before and after treatment. Results: The levels of SDBG, MAGE, LAGE, MODD and MPPGE in the observation group were (1.07 ± 0.53) mmol·L-1, (1.13 ± 0.47) mmol·L-1 and (4.69 ± 0.75) mmol·L- , (1.51 ± 0.23) mmol·L-1 and (3.05 ± 0.63) mmol·L-1 in the control group were significantly lower than those in the control group (1.62 ± 0.55 mmol·L-1, 2.15 ± 0.43 mmol·L- 1, (5.53 ± 0.81) mmol·L-1, (1.83 ± 0.21) mmol·L-1 and (3.87 ± 0.75) mmol·L-1, respectively The levels of FINS were (8.59 ± 1.28) mmol·L-1, (6.83 ± 0.76)% and (7.06 ± 0.88) m U · L-1, respectively, which were significantly lower than those in the control group (9.16 ± 1.77 mmol·L- 1, (7.68 ± 0.79)% and (9.75 ± 0.93) m U · L-1 respectively (P <0.05 or P <0.01). After treatment, the levels of HOMA-IR decreased in both groups. After treatment, the HOMA- 1.67 ± 0.45, respectively) (2.18 ± 0.53) (P <0.01). HOMA-β and ISI in both groups increased after treatment (P <0.01), and the levels of HOMA-β and ISI in the observation group were (67.5 ± 7.17) and (-2.75 ± 0.31), respectively, which were significantly higher than those of control group (60.6 ± 6.93) and (-3.31 ± 0.24) (P <0.01). Conclusion: Jiangtang Tongluo Decoction can reduce 2h PG and Hb A1c levels in T2DM patients, regulate intra-day blood glucose fluctuations and stabilize blood glucose. Its mechanism may be through improving β-cell secretion and thereby enhancing insulin sensitivity.