目的探讨甘精胰岛素和那格列奈联合阶段性中药辨证论治治疗高龄2型糖尿病的可行性及优势。方法将60例高龄2型糖尿病患者随机分为治疗组和对照组各30例。对照组予甘精胰岛素睡前皮下注射联合那格列奈口服,治疗组在对照组治疗基础上结合中医辨证分型,分别给予阴虚热盛、气阴两虚和阴阳两虚基本方治疗。两组疗程均为6个月。观察两组治疗前后血糖及血清C肽水平、中医证候评分和生活质量评分,并观察安全性。结果治疗组治疗3个月、6个月常见中医证候积分均明显改善(P<0.05或P<0.01),与对照组治疗后同时间比较,差异有统计学意义(P<0.05或P<0.01)。治疗组治疗3个月、6个月生活质量评分与治疗前比较,差异有统计学意义(P<0.05);与对照组治疗后同时间比较,差异有统计学意义(P<0.05)。两组治疗后血糖和C肽水平比较差异无统计学意义(P>0.05)。治疗组胰岛素日用量和低血糖发生率均明显低于对照组,差异有统计学意义(P<0.05)。结论高龄2型糖尿病患者应用甘精胰岛素和那格列奈联合阶段性中药辨证论治可有效控制血糖,提高生活质量,安全性高,优于单纯西药治疗。 Objective To investigate the feasibility and advantages of combination therapy of glargine and nateglinide in treatment of advanced type 2 diabetes mellitus based on syndrome differentiation. Methods Sixty elderly patients with type 2 diabetes were randomly divided into treatment group and control group, 30 cases each. Control group was given glargine subcutaneously before bedtime combined with nateglinide orally, the treatment group in the control group based on the combination of traditional Chinese medicine syndrome differentiation, were given yin deficiency heat Sheng, Qi and Yin deficiency and yin and yang deficiency of the basic side treatment. Two courses of treatment are 6 months. The blood glucose and serum C-peptide levels, TCM syndrome scores and quality of life scores were observed before and after treatment in both groups, and the safety was observed. Results The scores of common TCM syndromes were significantly improved in the treatment group at 3 months and 6 months (P <0.05 or P <0.01), and there was significant difference between the treatment group and the control group at the same time after treatment (P <0.05 or P < 0.01). The treatment group 3 months, 6 months quality of life score compared with before treatment, the difference was statistically significant (P <0.05); compared with the control group at the same time after treatment, the difference was statistically significant (P <0.05). There was no significant difference in blood glucose and C-peptide levels after treatment between the two groups (P> 0.05). The daily insulin dosage and the incidence of hypoglycemia in the treatment group were significantly lower than those in the control group (P <0.05). Conclusion The elderly type 2 diabetes patients with glargine and nateglinide combined with traditional Chinese medicine syndrome differentiation can effectively control blood sugar, improve quality of life, high safety, superior to Western medicine alone.