中医辨证治疗口服降糖西药控制不佳2型糖尿病患者46例临床观察

目的 初步评价中医辨证治疗口服降糖西药控制不佳2型糖尿病的临床疗效.方法 选择口服降糖药控制不佳的2型糖尿病患者138例,根据患者意愿及基线资料分为中医组、胰岛素组、联合组各46例,分别给予中医辨证治疗、胰岛素治疗、中医辨证+胰岛素治疗,治疗8周后检测空腹血糖(FPG)、餐后2小时血糖(2hPG)和糖化血红蛋白(HbAlc)水平,观察低血糖发生次数、治疗前后血脂指标及中医证候积分的变化,并进一步比较各组常见症状治疗前后出现的频数.结果 胰岛素组和联合组FPG、2hPG、HbAlc的降幅明显大于中医组(P＜0.05)；中医组和联合组低密度脂蛋白胆固醇(LDL-C)、中医证候积分及常见症状出现频次明显低于胰岛素组(P＜0.05)；联合组能明显降低日平均胰岛素剂量和低血糖事件的发生率,与胰岛素组比较差异有统计学意义(P＜0.05).结论 中医辨证治疗能明显改善口服降糖西药控制不佳2型糖尿病患者的血脂水平,在调节患者的症状方面具有积极作用,联合胰岛素治疗能在有效降糖的同时预防低血糖事件的发生.

Clinical Value of TCM Therapy for Type 2 Diabetes with Poor Glycemic Control

Objective To investigate the clinical value of traditional Chinese medicine(TCM) therapy for type 2 diabetes with poor glycemic control.Methods Totally 138 type 2 diabetes patients with poor glycemic control were divided into the TCM therapy group,insulin therapy group and the combo therapy group according to the willingnese and baseline data of the patients,with 46 in each.The corresponding therapy was given to each group respectively for 8 weeks.The levels of fasting blood glucose(FPG),2-hour postprandial blood glucose(2hPG) and glycosylated hemoglobin(HbAc1) were detected.The frequency of hypoglycemia,body weight,blood pressure,serum lipids and TCM symptom scores were observed before and after treatment.The frequency of common symptoms related to liver depression qi stagnation and phlegm stasis were compared among the three groups before and after treatment.Results After 8 weeks of treatment,the average decline of HbAc1 was 0.60%,1.50% and 1.78% in the TCM therapy group,insulin therapy group and combo therapy group respectively.The average decline of FPG was 1.1mmol/L,2.8mmol/L and 3.1mmol/L respectively.The average decline of 2hPG was 2.6mmol/L,4.5mmol/L and 5.8mmol/L respectively.The three glycemic index decreased significantly in the TCM therapy group as compared with other two groups(P<0.05).Comparing with the insulin therapy group,low-density lipoprotein C(LDL-C),TCM symptom scores and the frequency of common symptoms decreased significantly in TCM therapy group and combo therapy group(P<0.05).The combo therapy could significantly decrease the average daily insulin dosage and the frequency of hypoglycemia,with statistical difference between the insulin therapy group(P<0.05).Conclusion As a therapy for type 2 diabetes with poor glycemic control,TCM therapy is not good at controlling the glycemic level as compared with insulin.However,it could obviously improve the serum lipid level,relieve the symptoms,and prevent hypoglycemia as combined with insulin.