二甲双胍单用或联合沙格列汀对初发老年2型糖尿病患者胰岛B细胞功能的影响及疗效分析

摘要

Objective To evaluate the effect of metformin combined with saxagliptin on B cell functions in elderly patients with newly diagnosed type 2 diabetes. Methods A total of 110 elderly patients with newly diagnosed type 2 dia⁃betes were randomly assigned into metformin monotherapy group and metformin combined with saxagliptin group ( combination group ) . The fasting plasma glucose ( FPG ) , 2⁃hour postprandial ( 2hPG ) , fasting insulin ( FIns ) and hemoglobin( HbA1c) were detected before and 12 weeks after treatment. The index ofβcell function( HOMA⁃β) was also calculated. Results (1) In metformin monotherapy group, the levels of FPG,2hPG,HbA1c were respectively reduced to (7�23±2�05) mmol/L,(10�46±1�13) mmol/L and (6�94±2�03)% after 12 weeks(P<0. 05), and the levels of FIns and HOMA⁃β showed no statistical difference (P>0�05).(2) In combination group, the levels of FPG,2hPG and HbA1c were also obviously reduced after 12 weeks treatment ( P<0�05) . In addition, the levels of FIns and HOMA⁃βwere higher than before (P<0�05). (3) Compared with monotherapy group, there were significant decreases in FPG, 2hPG and HbA1c in the combination group, and significant increases in HOMA⁃β and FIns after 12 weeks� treatment(P<0�05). Conclusions Saxagliptin combined with metformin therapy can not only control the blood glucose efficiently but also im⁃prove the B cell function for the elderly patients with newly diagnosed type 2 diabetes mellitus.%目的观察二甲双胍单药治疗及联合DPP⁃4抑制剂沙格列汀对初发老年2型糖尿病患者胰岛B细胞功能的影响及血糖控制情况。方法选择初发老年2型糖尿病患者110例，随机分为沙格列汀联合二甲双胍治疗组（联用组）55例及二甲双胍单药治疗组（单用组）55例，测定2组治疗前及治疗12周后空腹血糖（FPG）、空腹胰岛素（FIns）、餐后2 h血糖（2hPG）、糖化血红蛋白（HbA1c），同时计算胰岛素分泌指数（HOMA⁃β），并进行组间比较。结果（1）单用组治疗12周后 FPG 由（8�13±1�12） mmol／L 降至（7�23±2�05） mmol／L，2hPG 由（12�26±2�72） mmol／L降至（10�46±1�13） mmol／L， HbA1c由（8�20±2�28）％降至（6�94±2�03）％，差异均有统计学意义（ P＜0�05），FIns、HOMA⁃β较治疗前升高但差异无统计学意义（ P＞0�05）。（2）联用组治疗12周后FPG由（8�39±1�21） mmol／L 降至（6�19±1�32） mmol／L，2hPG 由（12�39±2�64） mmol／L 降至（8�06±1�03） mmol／L， HbA1c由（8�22±2�10）％降至（6�23±1�90）％，以上3项指标均较治疗前明显下降（P＜0�05），且FIns、HOMA⁃β均高于同组治疗前（ P＜0�05）。（3）治疗12周后与单用组比较，联用组的FPG、2hPG以及HbA1c均显著降低（ P＜0�05），且FIns、HOMA⁃β均增加（ P＜0�05）。结论在初发老年2型糖尿病患者中二甲双胍联合沙格列汀不仅可有效地控制血糖，而且可改善胰岛B细胞功能。