预混胰岛素联合不同口服降糖药对2型糖尿病患者胰岛细胞功能及胰岛素敏感性的影响

摘要

Objective To investigate the effects of premixed insulin combined with oral hypoglycemic agents on islet cell function and insulin sensitivity in patients with type 2 diabetes.Methods Eighty seven patients with type 2 diabetes were randomly assigned to four groups:21 patients treated with insulin aspart 30 alone (aspart 30 group),23 with insulin aspart 30+metformin (metformin group),22 with insulin aspart 30+acarbose (acarbose group) and 21 with insulin aspart 30+sitagliptin (sitagliptin group) for 12 weeks.The islet β-cell function,insulin sensitivity,glucose effectiveness and insulin dose were compared among 4 groups.Results Islet beta cell function was significantly improved in all groups after treatment.HOMA-S and Matsuda index were improved in 3 combined treatment groups after treatment.The improvement in HOMA-S of the metformin group [median 60.22 (1.95,180.85) ％] and acarbose group [median 46.60 (-0.15,105.85)％] were better than that of aspart 30 group[median 4.33(-25.7,43.00)％](P＜0.05).The glycosylated hemoglobin levels in metformin group[(6.58 ± 1.05)％] and acarbose group [(6.54± 0.96) ％] were significantly lower than that in aspart 30 group [(7.60 ± 1.10) ％](P＜0.05).The daily insulin dose of acarbose and metformin groups were lower other groups.Conclusion Premixed insulin combined with oral hypoglycemic agents can improve insulin sensitivity and hypoglycemic efficacy,and reduce the daily insulin dose in patients with type 2 diabetes,however,no further improvement of islet beta cell function is found.%目的 探讨预混胰岛素联合不同口服降糖药对2型糖尿病患者胰岛β细胞功能、胰岛素敏感性的影响.方法 将87例2型糖尿病患者采用随机数字表法分为4组:门冬胰岛素30组21例,二甲双胍组23例,阿卡波糖组22例,西格列汀组21例,分别接受门冬胰岛素30单用、门冬胰岛素30+二甲双胍、门冬胰岛素30+阿卡波糖、门冬胰岛素30+西格列汀治疗至达标,持续治疗12周,比较胰岛β细胞功能、胰岛素敏感性、降糖疗效及胰岛素用量.结果 治疗后各组胰岛β细胞功能均明显好转,但组间比较均无统计学差异.联合治疗组治疗后胰岛素敏感指标稳态模型胰岛素敏感指数(HOMA-S)和总体胰岛素敏感指数[Matsuda指数)较治疗前均有改善,HOMA-S好转率二甲双胍组和阿卡波糖组大于门冬胰岛素30组(P＜0.05).联合治疗组空腹血糖、糖化血红蛋白较门冬胰岛素30组低,其中糖化血红蛋白二甲双胍组和阿卡波糖组与门冬胰岛素30组差异有统计学意义(P＜0.05).二甲双胍组和阿卡波糖组日胰岛素剂量低于其他两组.结论 预混胰岛素基础上联合口服降糖药能改善2型糖尿病患者胰岛素敏感性,其中以联合二甲双胍和阿卡波糖最佳,且降糖疗效更佳,胰岛素用量更少,未发现预混胰岛素基础上联合口服降糖药对β细胞功能有进一步改善.