阿卡波糖、沙格列汀联合甘精胰岛素对初发2型糖尿病患者血糖波动的影响

Effects of insulin glargine with acarbose or sagliptin on glycemic variability in initial type 2 diabetes mellitus

关键词:  2型糖尿病  血糖波动  动态血糖监测  糖化血红蛋白  血糖

Key words:  type 2 diabetes  glycemic variability  continuous glucose monitoring  glycosylated hemoglobin  blood glucose

摘要:

目的 研究阿卡波糖、沙格列汀联合甘精胰岛素对初发2型糖尿病患者血糖波动的影响。方法 将60例初发的2型糖尿病患者随机分为沙格列汀和甘精胰岛素组及阿卡波糖和甘精胰岛素组，在治疗前和治疗后3个月分别行72h动态血糖监测，比较空腹、餐后血糖，糖化血红蛋白及血糖波动指标。结果 两组患者治疗后空腹、餐后血糖，糖化血红蛋白均明显降低（均P＜0.01）；72h动态血糖监测提示，除低血糖发生外，其他血糖参数均明显改善（均P＜0.01）；72h动态血糖监测提示，两组治疗后均有2例患者有低血糖发生；与沙格列汀组比较，阿卡波糖组在餐后血糖（P＜0.01）、糖化血红蛋白（P＜0.01）、血糖标准差（P＜0.05）、平均血糖水平（P＜0.01）、早餐后平均血糖（P＜0.01）、中餐后平均血糖（P＜0.05）、血糖百分比(>7.8mmol/L，P＜0.01）方面明显降低，差异有统计学意义。结论 阿卡波糖、沙格列汀联合甘精胰岛素均能明显降低初发2型糖尿病患者血糖指标，减少血糖波动，阿卡波糖联合甘精胰岛素在降低糖化血红蛋白水平，尤其是餐后血糖方面更有优势。

Abstract:

Objective To investigate the effects of insulin glargine with acarbose or sagliptin on glycemic variability in patients with newly diagnosed type 2 diabetes mellitus(T2DM）. Methods Sixty patients with newly diagnosed T2DM were randomly divided into insulin glargine with sagliptin and insulin glargine with acarbose groups. Continuous glucose monitoring was performed for 72h before treatment and 3 months after treatment. Fasting, postprandial blood glucose, glycosylated hemoglobin and glycemic variability were compared between two groups. Results Fasting and postprandial blood glucose and glycosylated hemoglobin were significantly decreased in both groups after treatment(all P<0.01); 72h continuous glucose monitoring indicated that blood glucose parameters were significantly improved except hypoglycemia(all P<0.01); 72h continuous glucose monitoring indicated that hypoglycemia occurred in 2 patients in both groups after treatment. Compared with the sagliptin group, the acarbose group had significant decreases in postprandial blood sugar(P < 0.01), glycated hemoglobin(P < 0.01), standard deviation of blood sugar(P < 0.05), average blood sugar level(P < 0.01), average postprandial blood sugar(P < 0.01), percentage of blood sugar(>7.8mmol/L)(P < 0.01). Conclusion Insulin glargine combined with acarbose or sagliptin can significantly reduce blood sugar index and glycemic variability in newly diagnosed T2DM patients. Acarbose with glargine insulin has more advantages in lowering the glycosylated hemoglobin level, especially postprandial blood sugar.