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目的通过前瞻性、随机研究来探讨长期格列美脲治疗对2型糖尿病胰岛素抵抗和胰岛功能的影响。方法将69例初诊断2型糖尿病患者随机分为两组,均给予饮食、运动和二甲双胍基础治疗。治疗组加用格列美脲(37例),对照组加用瑞格列奈(32例),治疗时间2年。入组时和治疗结束时行口服葡萄糖耐量试验(OGTT)测定空腹血糖(FPG)、餐后2 h血糖(2hPG)、空腹胰岛素(FINS)、餐后2 h胰岛素(2hINS)、糖化血红蛋白(HbA1c)、血清甘油三酯(TG)、血清总胆固醇(TC)、收缩压(SBP)、舒张压(DBP)等指标;测量体重、身高。计算体质指数(BMI)、HOMA胰岛素抵抗指数(HOMA-IR)、HOMA胰岛细胞功能(HOMA-β)指数。结果治疗后两组的BMI、FPG、2hPG、HbA1c、HOMA-IR均较治疗前下降(P均<0.01),TC、TG较治疗前下降(P均<0.05),FINS、2hINS、HOMA-β均较治疗前升高(P均<0.01);对照组2hINS较治疗组升高明显(P<0.01),治疗组HOMA-β升高较对照组明显(P<0.05)。结论格列美脲联合二甲双胍对2型糖尿病的疗效不差于瑞格列奈联合二甲双胍,格列美脲长期治疗能改善患者胰岛功能、减轻胰岛素抵抗。
Objective To investigate the effects of long-term glimepiride therapy on insulin resistance and islet function in type 2 diabetes through a prospective, randomized study. Methods Sixty-nine newly diagnosed type 2 diabetic patients were randomly divided into two groups, all given diet, exercise and metformin basic treatment. The treatment group with glimepiride (37 cases), the control group with repaglinide (32 cases), the treatment time of 2 years. The levels of fasting plasma glucose (FPG), postprandial 2 h glucose (2 hPG), fasting insulin (FINS), 2 h insulin (2 hINS), glycosylated hemoglobin (HbA1c ), Serum triglyceride (TG), serum total cholesterol (TC), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured. Body weight and height were measured. Body mass index (BMI), HOMA insulin resistance index (HOMA-IR), HOMA islet cell function index (HOMA-β) were calculated. Results After treatment, BMI, FPG, 2hPG, HbA1c and HOMA-IR in both groups were significantly lower than those before treatment (all P <0.01) (P <0.01). The 2hINS in the control group was significantly higher than that in the treatment group (P <0.01). The HOMA-β level in the treatment group was significantly higher than that in the control group (P <0.05). Conclusion The combination of glimepiride and metformin is not inferior to repaglinide and metformin in type 2 diabetes. Long-term treatment with glimepiride can improve islet function and reduce insulin resistance.