利格列汀联合胰岛素治疗脆性糖尿病合并早期糖尿病肾病的临床观察

目的探讨利格列汀联合胰岛素给药治疗脆性糖尿病合并早期糖尿病肾病的临床效果。方法选取2014年1月至2017年5月在本院收治98例脆性糖尿病合并早期糖尿病肾病患者作为研究对象,按随机双盲分组,在使用胰岛素及贝那普利的基础上,分为口服利格列汀组及口服安慰剂对照组,疗程共12周。收集两组患者的一般资料、治疗前后胰岛素用量及血糖、血清C肽、胰高血糖素、GLP-1、GIP及尿微量白蛋白水平的变化情况。结果治疗12周后,利格列汀组患者的平均血糖、FBG、PPG均低于利格列汀治疗前和对照组患者治疗后(P<0.05);利格列汀治疗患者的血糖波动及指标变异(日内变异和日间变异)均小于治疗前和对照组治疗后的血糖波动(P<0.05)。利格列汀组治疗12周后,较治疗前患者的糖化血红蛋白、胰岛素用量下降(P<0.01),而治疗前后C肽和尿微量白蛋白水平差异均无统计学意义(P>0.05)。餐后30 min利格列汀组的胰高血糖素和GIP水平均低于治疗前和对照组治疗前后(P<0.01),而GLP-1(60 min)水平较治疗前和对照组均升高(P<0.01)。结论联合应用利格列汀和胰岛素治疗脆性糖尿病合并早期糖尿病肾病可使患者的糖化血红蛋白达标,血糖波动减小,减少胰岛素用量和低血糖发生减少,且不加重肾脏损害。

Clinical observation of linagliptin combined with insulin in the treatment of fragility diabetes complicated with early diabetic nephropathy

Objective To evaluate the clinical effect of linagliptin combined with insulin in the treatment of fragile diabetes complicated with early diabetic nephropathy.Methods From January 2014 to May 2017,98 patients with fragile diabetes complicated with early diabetic nephropathy were divided into two groups according to 1∶1 randomized,double-blind group.On the basis of insulin and benazepril,they were divided into oral linagliptin group and oral placebo control group.The course of treatment was 12 weeks.General data of age,sex,course of disease,height,weight,systolic and diastolic blood pressure,triglyceride,total cholesterol,blood urea nitrogen,cereatinine,uric acid and microalbuminuria were collected.After the subjects were enrolled in the group,self-blood glucose monitoring was performed to record their blood glucose control and fluctuation.The patients were followed up at baseline,4,8 and 12 weeks after treatment.Meanwhile,the changes of insulin dosage,blood sugar,serum C-peptide,glucagon,GLP-1,GIP and microalbuminuria levels were collected before and after treatment.Results After 12 weeks of treatment,the average blood sugar,FBG and PPG in the linagliptin group were lower than those before treatment and after treatment in the control group(P<0.05),while the FPG and PPG compliance rates increased(P<0.05).The blood sugar fluctuation and index variation(intra-day variation and inter-day variation)in the patients treated with linagliptin were higher than those before treatment and after treatment in the control group(P<0.05).The difference was less than the fluctuation of blood sugar before treatment and after treatment in the control group(P<0.05).After 12 weeks of treatment,HbA1c and insulin dosage in linagliptin group decreased compared with those before treatment(P<0.01),but there was no significant difference in C-peptide level and microalbuminuria before and after treatment(P>0.05).The levels of glucagon and GIP in the linagliptin group 30 minutes after meal were lower than those before and after treatment(P<0.01),while the levels of GLP-1(60 minutes)were higher than those before treatment and in the control group(P<0.01).Conclusions Combination of linagliptin and insulin in the treatment of fragile diabetes complicated with early diabetic nephropathy can achieve the target of HbA1c,decrease the fluctuation of blood sugar,decrease the dosage of insulin and the occurrence of hypoglycemia,without increasing risk of renal impairment.