应用磺脲类药物和二甲双胍治疗2型糖尿病失效后补充第3种降糖药的选择

目的:对应用磺脲类药物和二甲双胍后血糖仍控制不佳的2型糖尿病患者,观察补充第3种药物控制血糖的效果和安全性。方法:119例2型糖尿病患者(年龄(56.1±14.0)岁,糖化血红蛋白A(1HbA1c)(9.1±1.6)%)分为3组,分别随机补充甘精胰岛素、罗格列酮、阿卡波糖,根据血糖调整3种药物用量。补充药物治疗24周前、后,分别测定3组患者的HbA1c、空腹血糖(FPG)、体质量等指标变化。结果:甘精胰岛素组血糖(HbA1c(-1.66±0.24)%,FPG(-3.68±0.28)mmol·L-1)改善比罗格列酮组(HbA1c(-1.15±0.17)%,FPG(-2.85±0.26)mmol·L-1)、阿卡波糖组(HbA1c(-0.75±0.22)%,FPG(-1.85±0.26)mmol·L-1)更明显(P<0.05)。与口服降糖药(罗格列酮或者阿卡波糖)比较,甘精胰岛素组患者外周水肿、胃肠道反应等发生几率更少或更轻微(P<0.05),仅体质量增加比阿卡波糖组明显(P<0.05)。3组患者低血糖发生率和治疗费用差异无统计学意义(P>0.05)。结论:对应用磺脲类药物和二甲双胍后血糖仍控制不佳的2型糖尿病患者,补充甘精胰岛素比补充口服降糖药(罗格列酮或者阿卡波糖)降糖效力更强,且副作用无明显增加。

Optimal Addition of Third Hypoglycemic Therapy for Patients with Type 2 Diabetes after Treatment Failure with Metformin and Sulfonylurea

OBJECTIVE ： To evaluate the blood glucose control efficacy and safety of the third drug added for patients with type 2 diabetes whose blood glucose was poorly controlled after treatment with sulfonylurea and metformin. METHODS： 119 patients aged （56.1±14.0） years, HbA1c （9.1± 1.6）%] were randomly assigned to receive one of the three drugs ： glargine insulin, rosiglitazone and arcabose. The dosages were adjusted according to blood glucose levels. After 24 weeks, the levels of HbA,c, FPG and body weight and other indexes were measured. RESULTS： The improvement of blood glucose in insulin glargine group （HbA1c （- 1.66±0.24）%, FPG： （- 3.68±0.28）mmol. L^-1） was significantly better than that in the rosiglitazone group HbA1c： （- 1.15±0.17）%, FPG： （ -2.85±0.26）mmol-L^-1] and the acarbose group HbAlc： （ -0.75±0.22）%, FPG： （ -1.85±0.26）mmol-L^-1]（P〈 0.05）. Compared with the patients treated with oral antidiabetic drugs （rosiglitazone or acarbose） , those treated with insulin glargine showed less incidence（or milder） in peripheral edema and gastrointestinal reactions（P〈0.05） in spite of the more significant weight gain than that in the acarbose group（P〈0.05）. There were no significant differences among the 3 groups in the incidence of hypoglycemia and the treatment cost （P〉0.05）. CONCLUSION： As compared with oral antidiabetic drugs （rosiglitazone or acarbose）, the addition of insulin glargine showed more potent hypoglycemic efficacy yet similar side effects for patients with type 2 diabetes whose blood glucose levels were poorly controlled after treatment with sulfonylurea and metformin.