短期强化降糖序贯胰升血糖素样肽 1 对新诊断2 型糖尿病患者胰岛 β 细胞功能第一时相分泌的影响

摘要

目的 探讨胰岛素联合二甲双胍短期强化降糖序贯胰升血糖素样肽1(GLP-1)对新诊断T2DM 患者胰岛β细胞功能第一时相分泌的影响.方法 60例新诊断T2DM 患者予胰岛素联合二甲双胍强化降糖,使血糖短期内达标(FPG＜6.1 mmol/L,2 hPG＜8.0 mmol/L).继续巩固2周后随机分为饮食运动组(n=30)和利拉鲁肽组(n=30).经过10周的饮食运动及利拉鲁肽干预,比较干预前后胰岛β细胞功能第一时相分泌的变化.结果 与饮食运动组比较,利拉鲁肽组 FPG 水平下降( P＜0.05);两组胰岛素、C-P分泌水平升高(P＜0.05),但利拉鲁肽组升高更明显,且于4～6 min出现峰值(P＜0.05);两组胰岛素曲线下面积(AUCIns0～10min)、C-P曲线下面积(AUCC-P0～10min)均增加(P＜0.05).结论 胰岛素联合二甲双胍短期强化降糖序贯 GLP-1可改善 T2DM 患者胰岛β细胞功能第一时相分泌.%Objective To investigate the effects of GLP-1 treatment after short-term intensive glycemic control with insulin and metformin on the first-phase secretion of pancreatic β-cells in newly diagnosed type 2 diabetes mellitus (T2DM ) patients.Methods Sixty eligible newly diagnosed T2DM were recruited and firstly treated with insulin and metformin to accept intensive glycemic control (FPG＜6.1 mmol/L,2 hPG＜ 8.0 mmol/L ) in a short time.After 2 weeks of continuously intensive therapy, T2DM patients were randomly divided into diet-exercise group (n=30) and liraglutide group (n=30).After 10 weeks of diet-exercise or liraglutide intervention,the changes of the first-phase insulin secretion before and after intervention were compared.Results The levels of blood glucose significantly decreased in both groups.AUCIns 0～10 minand AUCC-P 0～10 min ncreased after diet-exercise intervention,with the same as in Iiraglutide group.Compared with diet-exercise intervention,patients treated with liraglutide accepted better glycemic control and presented first-phase insulin secretion peak in 4～6 min.Conclusion GLP-1 therapy continued to short-term intensive glycemic control with insulin and metformin can significantly improve the first-phase insulin secretion in newly diagnosed T2DM.