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目的:应用动态血糖监测系统(CGMS)评价那格列奈和瑞格列奈联合长效胰岛素来得时治疗新诊断的2型糖尿病(T2DM)患者的疗效和安全性。方法:采用随机自身交叉试验设计,选取新诊断的T2DM患者20例,在给予每晚睡前皮下注射基础胰岛素来得时将空腹血糖降至6～8 mmol.L-1基础上,维持剂量不变,按照1∶1比例随机分为两组,分别于3餐前15 min给予那格列奈(120 mg,3次.d-1)或瑞格列奈(1 mg,3次.d-1)治疗3 d,后3 d两药交叉,共计6 d,同时应用CGMS持续进行(154±6)h的血糖监测。结果:(1)那格列奈在控制餐前、餐后平均血糖水平与瑞格列奈比较,差异无统计学意义(P>0.05);(2)使用那格列奈与瑞格列奈的24 h平均血糖水平、血糖极差的差异无统计学意义(P>0.05);(3)使用那格列奈与瑞格列奈的日内血糖漂移最大幅度及平均血糖漂移幅度的差异无统计学意义(P>0.05);(4)使用那格列奈发生低血糖1次,瑞格列奈发生低血糖3次。结论:(1)三餐前口服那格列奈加睡前注射长效胰岛素类似物及三餐前口服瑞格列奈加睡前注射长效胰岛素类似物的两种治疗方案在控制血糖波动方面无明显差异;(2)那格列奈发生低血糖风险小,较瑞格列奈安全性好。
OBJECTIVE: To assess the efficacy and safety of the combination of nateglinide and repaglinide in combination with long-acting insulin in the treatment of newly diagnosed type 2 diabetes (T2DM) using the Dynamic Glucose Monitoring System (CGMS). METHODS: Twenty patients with newly diagnosed T2DM were selected by randomized crossover design. The fasting blood glucose was reduced to 6-8 mmol.L-1 after subcutaneous injection of basal insulin every night before bedtime to maintain the dose unchanged , Were randomly divided into two groups according to the ratio of 1: 1. Patients were given nateglinide (120 mg, 3 times .d-1) or repaglinide (1 mg, 3 times .d-1 ) For 3 days. After 3 days, the two drugs crossed for a total of 6 days. At the same time, CGMS was used to monitor the blood glucose level for (154 ± 6) h. Results: (1) Before nateglinide control, the mean postprandial plasma glucose level was not significantly different from repaglinide (P> 0.05). (2) The effect of nateglinide and repaglinide (P> 0.05). (3) There was no statistical difference in the maximum intra-day glucose excursion and the average glucose excursion between nateglinide and repaglinide Significance (P> 0.05). (4) Hypoglycemia occurred 1 time with nateglinide and 3 times with repaglinide. Conclusions: (1) The two treatments of oral administration of nateglinide before bedtime and long-acting insulin analogue before bedtime and oral repaglinide before bedtime and long-acting insulin analogue before bedtime were not obvious in controlling blood sugar fluctuation Difference; (2) nateglinide with low risk of hypoglycemia, better than repaglinide safety.