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目的观察西格列汀联合胰岛素泵强化治疗初发2型糖尿病的临床疗效。方法 60例初发2型糖尿病患者随机分为两组,A组(28例):胰岛素泵强化治疗;B组(32例):西格列汀+胰岛素泵强化治疗。治疗为期4周,治疗前和治疗持续4周停泵3 d后均行馒头餐-胰岛素-C肽释放试验,于0、30、120 min分别检测血糖(GLU)、胰岛旨(INS)、C肽(CP),比较治疗前后GLU、甘油三脂(TG)、总胆固醇(TC)、低密度脂蛋白-胆固醇(LDL-C)、INS、CP、HbA 1c、ΔI30/ΔG30、HOMA-IR、120 min CP-0 min CP、白蛋白/肌酐比值(ACR)等指标的变化。结果 1经4周强化治疗后,两组各时间点(0、30、120 min)血糖和Hb A1c较治疗前显著下降(P<0.01),TG、尿ACR水平显著降低(P<0.05),同时ΔI30/ΔG30、HOMA-IR、ΔCP明显改善(P<0.01)。2与治疗前比较,治疗后两组30 min及120 min INS均增加,差异具有统计学意义(P<0.05)。治疗后两组各时间点C肽均明显上升,差异有统计学意义(P<0.05)。3与治疗后A组比较,治疗后B组120 min血糖下降更为明显(P<0.05),120 min INS、120 min CP及ΔCP水平均显著增加(P<0.05),ΔI30/ΔG30、HOMA-IR改善更明显(P<0.05)。结论西格列汀联合胰岛素泵强化治疗在降低餐后血糖水平,改善胰岛素早相分泌及胰岛素抵抗方面可能更优于单纯胰岛素泵强化治疗,同时可改善早期糖尿病肾病。
Objective To observe the clinical efficacy of sitagliptin combined with insulin pump in the treatment of newly diagnosed type 2 diabetes mellitus. Methods Sixty patients with newly diagnosed type 2 diabetes were randomly divided into two groups: group A (28 cases): insulin pump intensive treatment; group B (32 cases): sitagliptin + insulin pump intensive treatment. The treatment of 4 weeks, before treatment and treatment for 4 weeks after stopping the pump 3 days after the steamed bread meal - insulin-C peptide release test at 0,30,120 min were measured blood glucose (GLU), insuline (INS), C The levels of GLU, TG, TC, LDL-C, INS, CP, HbA 1c, ΔI30 / ΔG30, HOMA-IR, 120 min CP-0 min CP, albumin / creatinine ratio (ACR) and other indicators of change. Results 1 After 4 weeks of intensive treatment, blood glucose and Hb A1c at each time point (0, 30, 120 min) decreased significantly (P <0.01), while TG and urine ACR decreased significantly (P <0.05) At the same time ΔI30 / ΔG30, HOMA-IR, ΔCP significantly improved (P <0.01). 2 Compared with those before treatment, the levels of INS increased at 30 min and 120 min after treatment in both groups, with statistical significance (P <0.05). After treatment, C peptide in both groups increased significantly at each time point, the difference was statistically significant (P <0.05). (P <0.05), 120 min CP and 120 min CP increased significantly (P <0.05), ΔI30 / ΔG30, HOMA- IR improved more significantly (P <0.05). Conclusions Sitagliptin combined with insulin pump therapy may be superior to insulin pump alone in reducing postprandial blood glucose levels, improving insulin premature secretion and insulin resistance, and improving early diabetic nephropathy.