西格列汀治疗脆性糖尿病的有效性及安全性观察

目的 评价西格列汀在每日多次胰岛素注射(MDI)治疗血糖控制不良的脆性糖尿病中的有效性和安全性.方法 27例MDI治疗血糖控制不良的脆性糖尿病患者,在原方案基础上加用西格列汀100 mg· d-1,治疗12周,观察治疗前后患者的糖化血红蛋白(HbA1C)、1,5-脱水葡萄糖醇(1,5-AG)、血糖水平标准差(SDBG)、平均血糖波动幅度(MAGE)、体质量指数(BMI)和胰岛素剂量等指标的变化.结果 HbA1C从基线时的(8.4 ±1.2)%下降到12周时的(7.3 ±2.5)%(P<0.05),三餐前和三餐后2 h血糖均较基线下降,全天胰岛素剂量较基线减少(P<0.05).1,5-AG从基线时的(7.3 ±3.3)mg· L-1上升到12周时的(9.8 ±4.5)mg· L-1(P<0.05),SDBG和MAGE均较基线下降(P<0.05).BMI没有变化,低血糖事件减少.基线BMI与HbA1C变化值呈正相关.年龄与1,5-AG变化值呈正相关,与SDBG和MAGE变化值呈负相关.结论 西格列汀改善MDI治疗血糖控制不良的脆性糖尿病的血糖控制和血糖波动,减少低血糖事件,不增加体质量.

Efficacy and safety of sitagliptin in the treatment of fragile diabetes

Objective To evaluate the efficacy and safety of sitagliptin in the treatment of fragile diabetes with poor glycemic control by multiple insulin injections(MDI)daily.Methods Twenty-seven patients with fragile diabetes mellitus treated with MDI with poor gly-cemic control on the basis of original plan were treated with sitagliptin 100 mg· d-1for 12 weeks.HbA1C,1,5-dehydration Glucose al-cohol(1,5-AG),standard deviation of blood glucose level(SDBG),average blood glucose volatility(MAGE),body mass index (BMI),insulin dosage and other indicators were observed before and after treatment.Results The HbA1C decreased from(8.4 ± 1.2)%at baseline to(7.3 ±2.5)%at 12 weeks(P<0.05),and blood glucose levels before three meals and two hours after meals, insulin dose were decreased compare with baseline(P<0.05).1,5-AG increased from(7.3 ±3.3)mg· L-1at baseline to(9.8 ± 4.5)mg· L-1at 12 weeks(P<0.05).Both SDBG and MAGE decreased compared with baseline(P<0.05).There was no change in BMI and hypoglycemic events decreased.The baseline BMI was positively correlated with the HbA 1C change.Age was positively cor-related with the change in 1,5-AG and negatively correlated with changes in SDBG and MAGE.Conclusions Sitagliptin improves blood glucose control and blood glucose fluctuations in fragile diabetes with poor blood glucose control by MDI,reduces hypoglycemic e-vents,and does not increase body mass.