目的：观察地特胰岛素联合二甲双胍对早期糖尿病患者微血管并发症及糖脂代谢的影响。方法采用单中心、随机、对照研究方法，将140例早期糖尿病患者随机化分为两组，观察组和对照组各70例。观察组采用地特胰岛素联合二甲双胍干预，对照组单纯采用二甲双胍干预，两组患者均治疗3个月，随访2年。对比两组患者微血管并发症及糖脂代谢指标的变化情况。结果与对照组比较，观察组治疗后可显著降低空腹血糖、餐后2 h血糖、空腹胰岛素水平、胰岛素抵抗指数、总胆固醇、低密度脂蛋白、三酰甘油、体质指数、腰围和腰臀比，并能显著增高胰岛素分泌指数、高密度脂蛋白，治疗前后差异均有统计学意义（P＜0.05）。随访2年，与对照组比，观察组的糖尿病肾病和糖尿病视网膜病变发生率较少，差异有统计学意义（P＜0.05）。结论地特胰岛素联合二甲双胍能够有效改善早期糖尿病患者的糖脂代谢，预防和降低患者微血管并发症的发生。%Objective To investigate the effect of insulin detemir combined with metformin in microvascular complications and lipid metabolism in treatment of early diabetic patients.Methods A single-center randomized controlled design was used. 140 early diabetic patients were randomly divided into two groups: 70 patients in the observation group and 70 patients in the control group. The observation group was treated by insulin detemir combined with metformin. The control group was treated with metformin alone. Glucose and lipid metabolism indicators and microvascular complications were collected and compared within two groups after three months treatment and 2 years follow-up.Results After treatment, fasting plasma glucose(FPG), 2 hour postprandial blood glucose(2 hPG), Hemoglobina1c (HbA1c), fasting serum insulin(Fins), homeostasis model assessment insulin resistance(HOMA-IR), total cholesterol(TC), low-density lipoprotein (LDL), triglyceride(TG), body mass index(BMI), waist circumference(WC)and waist-hip ratio(WHR) were decreased(P<0.05), HOMA-β and high-density lipoprotein (HDL) were increased (P<0.05) in the observation group significantly compared with the control group. After 2 years follow-up, the cases of diabetic nephropathy and diabetic retinopathy were decreased in the observation group, compared with the control group (P<0.05).Conclusion Insulin detemir combined with metformin can improve glucose and lipid metabolism and effectively prevent and reduce the incidence of early microvascular complications in patients with diabetes.
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