论文部分内容阅读
多数老年2型糖尿病患者合并及并发多种基础疾病,多存在有心、肝、肾、脑、胰腺等器官功能的不同程度减退。美国前瞻性糖尿病研究显示,理想的血糖控制并不能阻止胰岛β细胞功能的进行性衰竭~([1])。病因可归于胰岛细胞功能缺损~([2]),通过肠促胰岛素(incretin)激素作用而改善胰岛功能是治疗2型糖尿病的新途径。葡萄糖依赖性促胰岛素分泌多肽(GIP)和胰高血糖-1(GLP-1)素样肽是人类重要的肠促胰岛素激素,因用餐刺激而分泌的胰岛素有50%~60%通过GIP和GLP-1实现~([3])。GIP和GLP-1仅在高血糖情况下增加胰岛素的分泌,而血糖正常和低血糖时不增加胰岛素分泌~([4])。2型糖尿病患者的incretin作用减弱,对GIP反应减弱,而保留对GLP-1反应,糖尿病患者血浆GLP-1浓度低。GLP-1由肠道L细胞分泌,具有促进胰岛素分泌,促进胰岛细胞生长、增殖和分化并抑制胰岛β细胞凋亡等多种作用。二肽基肽酶Ⅳ(DPP-4)抑制剂通过抑制DPP-4,减少GLP-1的降解,增加GLP-1的血浆浓度,改善餐后血糖控制。此外DPP-4抑制剂还抑制GIP,垂体腺苷酸环化酶激活多肽,胃泌素释放肽等参与糖调节的其他肽类的降解。因此,除GLP-1外,DPP-4抑制剂可能具有有益于糖尿病治疗的作用,并且可能最大限度保护胰岛功能,不增加体重,避免低血糖等。我科自2014年6月用利格列汀(商品名:欧唐宁)治疗血糖控制欠佳的老年T_2DM获得了一些临床体会,汇报如下:
Most elderly patients with type 2 diabetes mellitus and complicated by a variety of underlying diseases, there are many heart, liver, kidney, brain, pancreas and other organ function decline to varying degrees. Prospective diabetes studies in the United States have shown that optimal glycemic control does not prevent the progressive failure of pancreatic β-cell function (1). The etiology can be attributed to islet cell dysfunction ~ ([2]). Improving pancreatic islet function through incretin hormones is a novel approach for the treatment of type 2 diabetes. Glucose-dependent insulinotropic polypeptide (GIP) and pancreatic hyperglycemia-1 (GLP-1) -like peptide are important human incretin hormones, and 50% -60% of insulin secreted by meal stimuli pass through GIP and GLP -1 to achieve ~ ([3]). GIP and GLP-1 only increase insulin secretion in the case of hyperglycemia, whereas normal blood glucose and hypoglycemia do not increase insulin secretion (4). Patients with type 2 diabetes have an impaired incretin effect, a diminished response to GIP, and a retained response to GLP-1, with low plasma GLP-1 concentrations in diabetic patients. GLP-1 is secreted by gut L cells and plays a variety of roles such as promoting insulin secretion, promoting islet cell growth, proliferation and differentiation, and inhibiting pancreatic β-cell apoptosis. Dipeptidyl peptidase IV (DPP-4) inhibitors can improve postprandial glycemic control by inhibiting DPP-4, decreasing GLP-1 degradation, increasing plasma concentration of GLP-1. In addition, DPP-4 inhibitors also inhibit the degradation of other peptides involved in the regulation of glucose, such as GIP, pituitary adenylate cyclase activating polypeptide, gastrin-releasing peptide and the like. Therefore, in addition to GLP-1, DPP-4 inhibitors may have beneficial effects in the treatment of diabetes and may maximize islet function without increasing body weight, avoiding hypoglycaemia and the like. Our department has obtained some clinical experience with the treatment of elderly patients with poorly controlled glycemic control of T2DM with linagliptin (trade name: Otdanine) in June 2014. The report is as follows: