T2DM患者短期胰岛素泵强化治疗后应用不同序贯治疗方案的临床效果

目的探究2型糖尿病(T2DM)患者短期胰岛素泵强化治疗(CSII)后应用不同的序贯治疗方案的效果。方法78例T2DM患者作为研究对象,根据序贯治疗方案不同分为MET组、STG组和LIR组,每组26例。三组患者均给予饮食、运动以及血糖监测等内容指导和CSII治疗,MET组采用二甲双胍进行序贯治疗,STG组采用西格列汀进行序贯治疗,LIR组采用利拉鲁肽进行序贯治疗。比较三组患者临床指标治疗后0~10 min胰岛素曲线下面积的改变值(ΔAUC_(Ins 0~10 min))、治疗后体质量指数的改变值(ΔBMI)、治疗后糖化血红蛋白的改变值(ΔHbA1c)、治疗后稳态模型胰岛β细胞功能指数的改变值(ΔHOMA-β)、治疗后的稳态模型胰岛素抵抗指数改变值(ΔHOMA-IR)、治疗后0~8 min胰升血糖素曲线下面积的改变值(ΔAUC_(Glu 0~8 min))]及不良反应发生情况。结果MET组患者的ΔBMI、ΔHbA1c、ΔHOMA-IR、ΔAUC_(Ins 0~10 min)、ΔHOMA-β、ΔAUC_(Glu 0~8 min)分别为(-0.2±0.1)kg/m²、(-1.4±0.4)%、(-0.9±0.2)、(15.6±4.3)mU·min、(12.8±6.4)、(-30.3±8.1)μg·min,STG组分别为(-0.1±0.1)kg/m²、(-0.8±0.2)%、(-0.5±0.2)、(52.0±4.9)mU·min、(30.8±7.3)、(-81.5±5.9)μg·min,LIR组分别为(-1.4±0.3)kg/m²、(-1.0±0.4)%、(-1.3±0.3)、(81.2±7.5)mU·min、(48.2±5.6)、(-115.4±8.1)μg·min。LIR组的ΔBMI、ΔHOMA-IR、ΔAUC_(Glu 0~8 min)均低于MET组和STG组,差异具有统计学意义(P<0.05);MET组的ΔBMI和ΔHOMA-IR均低于STG组,ΔAUC_(Glu 0~8 min)高于STG组,差异具有统计学意义(P<0.05)。MET组的ΔHbA1c、ΔAUC_(Ins 0~10 min)、ΔHOMA-β均低于STG组和LIR组,差异具有统计学意义(P<0.05);STG组的ΔHbA1c高于LIR组、ΔAUC_(Ins 0~10 min)和ΔHOMA-β均低于LIR组,差异具有统计学意义(P<0.05)。治疗后,三组患者均无严重不良反应,MET组发生消化道系统症状3例(11.54%),STG组发生消化道系统症状4例(15.38%),LIR组发生消化道系统症状5例(19.23%),三组患者的不良反应发生率对比差异无统计学意义(P>0.05)。结论T2DM患者在CSII后,采用利拉鲁肽等长促胰素药物较二甲双胍以及西格列汀的序贯疗法,在改善T2DM病理生理缺陷方面效果更明显,值得应用与推广。

Clinical effect of different sequential regimens after continuous subcutaneous insulin infusion in T2DM patients

Objective To investigate the effect of different sequential regimens after continuous subcutaneous insulin infusion(CSII)in type 2 diabetes mellitus(T2DM)patients.Methods A total of 78 patients with T2DM as the research subjects were divided into MET group,STG group and LIR group according to different sequential regimens,with 26 cases in each group.All three groups were given guidance on diet,exercise and blood glucose monitoring and CSII treatment.The MET group was sequentially treated with metformin,the STG group was sequentially treated with sitagliptin,and the LIR group was sequentially treated with liraglutide.Comparison was made on clinical indexeschange of area under the curve of insulin at 0-10 min after treatment(ΔAUC_(Ins 0-10 min)),change of body mass index after treatment(ΔBMI),change value of glycosylated hemoglobin after treatment(ΔHbA1c),change of homeostasis model assessment-β(ΔHOMA-β),change of homeostasis model assessment-insulin resistance(ΔHOMA-IR),change value of area under the curve of glucose at 0-8 min after treatment(ΔAUC_(Glu 0-8 min))],and occurrence of adverse effects among three groups.Results TheΔBMI,ΔHbA1c,ΔHOMA-IR,ΔAUC_(Ins 0-10 min),ΔHOMA-β,ΔAUC_(Glu 0-8 min) were(-0.2±0.1)kg/m²,(-1.4±0.4)%,(-0.9±0.2),(15.6±4.3)mU·min,(12.8±6.4),(-30.3±8.1)μg·min in the MET group,(-0.1±0.1)kg/m²,(-0.8±0.2)%,(-0.5±0.2),(52.0±4.9)mU·min,(30.8±7.3),(-81.5±5.9)μg·min in the STG group,and(-1.4±0.3)kg/m²,(-1.0±0.4)%,(-1.3±0.3),(81.2±7.5)mU·min,(48.2±5.6),(-115.4±8.1)μg·min in the LIR groups.TheΔBMI,ΔHOMA-IR,andΔAUC_(Glu 0-8 min) in the LIR group were lower than those in the MET and STG groups,and the differences were statistically significant(P<0.05).TheΔBMI andΔHOMA-IR in the MET group were lower than those in the STG group,and theΔAUC_(Glu 0-8 min) was higher than that in the STG group.All the differences were statistically significant(P<0.05).TheΔHbA1c,ΔAUC_(Ins 0-10 min),andΔHOMA-βof the MET group were lower than those of the STG group and the LIR group,and the difference was statistically significant(P<0.05).TheΔHbA1c of the STG group was higher than that of the LIR group,and theΔAUC_(Ins 0-10 min) andΔHOMA-βwere lower than those of the LIR group,and the difference was statistically significant(P<0.05).After treatment,there were no serious adverse reactions in any of the three groups.Gastrointestinal system symptoms occurred in 3 cases(11.54%)in the MET group,4 cases(15.38%)in the STG group,and 5 cases(19.23%)in the LIR group.The difference in the incidence of adverse reactions among the three groups was not statistically significant(P>0.05).Conclusion Compared with the sequential therapy of metformin and sitagliptin,liraglutide is more effective in improving the pathophysiological defects of T2DM after continuous subcutaneous insulin infusion,which is worthy of application and promotion.