降糖通络汤对2型糖尿病患者血糖波动的影响

目的:观察降糖通络汤对2型糖尿病(type 2 diabetes,T2DM)患者血糖波动的影响。方法:将90例T2 DM患者采用随机数字法分为对照组和观察组各45例。对照组采用阿卡波糖片及重组甘精胰岛素注射液以控制血糖。观察组在对照组治疗基础上加用降糖通络汤,1剂·d-1。两组疗程均为12周。采用动态血糖监测系统监测血糖水平的标准差(standard deviation,SDBG)、日内平均血糖波动幅度(mean amplitude of glycemic excursions,MAGE)、日内血糖极差(Largest amplitude of glycemic excursions,LAGE)、日间血糖平均绝对差(absolute means of daily differences,MODD)及餐后血糖波动均值(mean of postprandial glucose excursion,MPPGE),检测空腹血糖(Fasting blood-glucose,FBG)、餐后2小时血糖(postprandial blood glucose 2 hour,2h PBG)、糖化血红蛋白(glycosylated hemoglobin,Hb Alc)及空腹胰岛素(fasting insulin,FINS),并计算胰岛素抵抗指数(homeostasis model assessment,HOMA-IR)、胰岛β细胞分泌功能指数(homa beta cell function index,HOMA-β)和胰岛素敏感指数(Insulin sensitive index,ISI),治疗前后各评价1次。结果:观察组治疗后SDBG、MAGE、LAGE、MODD及MPPGE水平分别为(1.07±0.53)mmol·L-1、(1.13±0.47)mmol·L-1、(4.69±0.75)mmol·L-1、(1.51±0.23)mmol·L-1及(3.05±0.63)mmol·L-1,均显著低于对照组的(1.62±0.55)mmol·L-1、(2.15±0.43)mmol·L-1、(5.53±0.81)mmol·L-1、(1.83±0.21)mmol·L-1及(3.87±0.75)mmol·L-1(P0.01);治疗后观察组2h PG、Hb A1c及FINS水平分别为(8.59±1.28)mmol·L-1、(6.83±0.76)%及(7.06±0.88)m U·L-1,均显著低于对照组的(9.16±1.77)mmol·L-1、(7.68±0.79)%及(9.75±0.93)m U·L-1(P0.05或P0.01);治疗后两组HOMA-IR水平下降,治疗后观察组HOMA-IR水平为(1.67±0.45)低于对照组的(2.18±0.53)(P0.01);治疗后两组HOMA-β和ISI较治疗前上升(P0.01),观察组HOMA-β和ISI水平为(67.5±7.17)和(-2.75±0.31),均高于对照组的(60.6±6.93)和(-3.31±0.24)(P0.01)。结论:降糖通络汤能降低T2DM患者2h PG和Hb A1c水平,调节日内血糖波动、稳定血糖,其作用机制可能是通过改善β细胞分泌功能,从而提高机体胰岛素敏感性。

Hypoglycemic Effect of Jiangtang Tongluo Tang on Blood Glucose Fluctuations of Type 2 Diabetes

Objective:To observe the hypoglycemic effect of Jiangtang Tongluo Tang on blood glucose fluctuations of type 2 diabetes (T2 DM).Methods:90 patients with T2 DM were randomly divided into control group and observation group,with 45 cases in each group.The control group was treated with acarbose tablets and recombinant glargine insulin injections to control blood sugar.Based on that,the observation group was treated with hypoglycemic Jiangtang Tongluo decoction.The treatment lasted for 12 weeks.Glucose monitoring system was applied to monitor the standard deviation (SDBG)of blood glucose levels,mean amplitude of glycemic excursions (MAGE),largest amplitude of glycemic excursions (LAGE),absolute means of daily differences (MODD),mean of postprandial glucose excursion (MPPGE),fasting blood-glucose (FBG),2 hour postprandial blood glucose (2h PBG),glycosylated hemoglobin (HbAlc),fasting insulin (FINS),homeostasis model assessment (HOMA-IR),homa beta cell function index (HOMA-β) and insulin sensitive index (ISI) before and after treatment.Results:The SDBG,MAGE,LAGE,MODD and MPPGE level after treatment was (1.07 ±0.53) mmol · L-1,(1.13 ±0.47) mmol · L-1,(4.69 ±0.75) mmol · L-1,(1.51 ±0.23) mmol · L-1 and (3.05 ± 0.63) mmol · L-1 respectively,each being significantly lower than that of the control group of (1.62 ± 0.55) mmol · L-1,(2.15 ±0.43) mmol · L-1,(5.53 ±0.81) mmol · L-1,(1.83 ±0.21) mmol · L-1 and (3.87 ±0.75) mmol · L-1(P＜0.01).After treatment,the 2hPG,HbA1c and FINS level of the observation group was (8.59 ± 1.28) mmol · L-1,(6.83 ±0.76)％ and (7.06 ± 0.88) mU · L-1 respectively,each being significantly lower than that of the control group of (9.16 ± 1.77) mmol ·L-1,(7.68 ± 0.79) ％ and (9.75 ± 0.93) mU · L-1 (P ＜ 0.05 or P ＜ 0.01).After treatment,the HOMA-IR levels of both groups decreased,with that of the observation group being lower than that of the control group(P ＜0.01).After treatment,HOMA-β and ISI of both groups increased,with that of the observation group being higher than that of the control group (P ＜ 0.01).Conclusion:Jiangtang Tongluo Tang can reduce T2DM patients' 2hPG and HbA1 c levels,regulate blood sugar intraday fluctuations,stabilize blood sugar.The mechanism of that maybe exists in increasing human body's sensitivity to insulin through improving the β-cell function.