甘精胰岛素治疗2型糖尿病有效性及安全性的多中心临床研究

目的 观察对于尚未使用胰岛素治疗血糖控制不佳的2型糖尿病患者,启动甘精胰岛素治疗的有效性、安全性和可行性.方法 为多中心、开放性、自身对照的临床观察性研究,共22个研究中心565例2型糖尿病患者参与.患者在0～3种口服降糖药治疗的基础上联合应用甘精胰岛素治疗12周后,评价甘精胰岛素治疗的有效性和安全性.结果 受试者平均糖化血红蛋白(Hb)Alc由基线时的8.0%±0.99%下降至6.3%±0.64%(P＜0.01).以HbAlC＜6.5%以及＜7.0%为目标值,达标率分别为66.55%和87.61%.患者全天7点血糖包括3餐前血糖、3餐后血糖及睡前血糖均得到明显改善.治疗期间有92例(16.3%)受试者发生低血糖事件129次,均为一般性低血糖,发生率为0.91次/(患者·年).体重及体重指数均有所下降;无肝、肾功能损伤,其他不良反应轻微.结论 对于经单纯生活方式干预或口服降糖药治疗血糖控制不佳的2型糖尿病患者,早期启动甘精胰岛素作为胰岛素的起始治疗用药,可使大多数患者安全、有效地达标.     

盐酸吡格列酮治疗2型糖尿病的有效性和安全性的多中心临床研究

目的　评价盐酸吡格列酮对 2型糖尿病患者合用磺脲类和双胍类药物时的降血糖作用 ,观察其安全性。方法　采用随机、双盲、安慰剂平行对照和多中心临床研究方法。对 2 83例应用磺脲类和双胍类治疗而血糖控制不佳 (7 0mmol/L≤空腹血糖 <13 0mmol/L)的 2型糖尿病患者随机分入吡格列酮 30mg组与安慰剂组治疗随访 6次共 12周。结果　于 12周时 ,试验组与对照组空腹血糖水平较基线值分别平均下降了 1 1mmol/L和 0 4mmol/L(P <0 0 0 1) ;餐后血糖分别下降了 1 5mmol/L和 0 3mmol/L(P <0 0 0 1) ;糖化血红蛋白 (HbA1c)分别下降了 0 7%和 0 4 % (P <0 0 1)。试验组空腹胰岛素下降幅度高于对照组 (P <0 0 5 ) ,其两组治疗前后的差值比较均分别具有显著性统计学差异。试验组HOMA IR显著降低 (P <0 0 1)。结论　 12周的临床观察显示 ,对 2型糖尿病患者饮食、运动和口服降糖药 (磺脲类和双胍类 )治疗控制不佳者联合应用吡格列酮 (30mg/d) ,代谢控制可得到进一步的改善 ,胰岛素的敏感性增强 ,安全性和耐受性好。     

格列吡嗪控释片治疗老年2型糖尿病的疗效及药理作用

目的探讨对格列吡嗪控释片治疗老年2型糖尿病的疗效以及药理作用进行探讨。方法选取该院在2012年8月—2013年8月份收治的80例老年2型糖尿病患者为研究对象,随机分组,对照组实施二甲双胍治疗,实验组实施格列吡嗪控释片治疗。对两组患者的临床疗效进行观察和比较。结果实验组FBG、F2BG水平相比对照组改善明显,治疗总有效率相比对照组更高,差异明显,有统计学意义（P〈0.05）。结论采用格列吡嗪控释片对老年2型糖尿病患者进行治疗,疗效理想,安全可靠,值得普及和应用。     

一天一次格列吡嗪控释片和格列吡嗪速释片治疗2型糖尿病病人的有效性的比较

为比较格列毗嗪控释片（格列吡嗪-GITS[胃肠道治疗系统]）和格列吡嗪速释片治疗2型糖尿病（NIDDM）病人的有效性和安全性。Berelowitz M,Fischette C等人进行了一项多中心、开放、随机、     

胰岛素联合吡格列酮治疗2型糖尿病疗效观察

2002年2月～2004年2月,我们应用胰岛索加吡格列酮治疗口服降糖药失败的2型糖尿病（T2DM）患者54例,效果良好。现报告如下。     

格列吡嗪控释片对2型糖尿病患者血管内皮功能的影响

目的　探讨格列吡嗪控释片对2型糖尿病患者血管内皮功能的影响。方法　76例2型糖尿病者,经2周洗脱期后,随机分为两组。一组4 0例应用格列吡嗪控释片;另一组36例应用格列本脲。根据达到目标血糖调整药物剂量,单药未能达标者加用阿卡波糖,治疗期12周。每位患者均采用高分辨率超声显像法,分别于治疗前后各进行一次右肱动脉血管内皮功能检测。结果　格列本脲组治疗前后肱动脉内径基础值、反应性充血及含服硝酸甘油后肱动脉内径变化,均无显著性差异[(3. 70±0 . 5 7)mm对(3 .72±0 . 5 9)mm ,(5 . 4 6±0 .82 ) %对(5 .70±0 .84 ) % ,(2 0 . 5±5 . 0 ) %对(2 0 . 1±5 . 1) % ,P >0 .0 5 ]。格列吡嗪控释片组治疗前后肱动脉内径基础值、含服硝酸甘油后肱动脉内径的变化,也无显著性差异[(3 .72±0 . 6 2 )mm对(3 .73±0 . 6 3)mm ,(19. 8±5. 5 ) %对(19. 9±5 . 8) % ,P >0 . 0 5 ];但反应性充血引起肱动脉内径变化,治疗前后具有非常显著性差异[(5. 6 7±0 .79) %对(9. 4 6±3 .81) % ,P <0 . 0 1]。结论　格列吡嗪控释片可能改善2型糖尿病者的血管内皮功能。     

格列美脲与格列吡嗪治疗2型糖尿病疗效比较

目的比较格列美脲与格列吡嗪治疗2型糖尿病的疗效。方法将42例2型糖尿病患者随机分为格列美脲组与格列吡嗪组。格列美脲组20例,格列吡嗪组22例,观察时间12周。治疗前后监测病人空腹血糖(FBG)、餐后2小时血糖(2hPBG)、空腹胰岛素(FINS)、餐后2小时胰岛素(2hPINS)、糖化血红蛋白(HbA1c)、体重指数(BMI)。结果两组治疗前后FBG、2hPBG、HbA1c均明显下降(P<0.05),但两组相比差异无统计学意义;两组治疗前后FINS差异无统计学意义;格列美脲组2hPINS和BMI升高低于格列吡嗪组,差异有统计学意义(P<0.05),低血糖发生率显著低于格列吡嗪组(P<0.05)。结论格列美脲降糖效果好,使用安全。     

格列吡嗪控释片治疗老年2型糖尿病的临床效果及药理作用分析

目的分析格列吡嗪控释片治疗老年2型糖尿病的临床效果及药理作用。方法2017年3月—2018年3月间随机分组,对照组常规给予二甲双胍治疗,观察组给予格列吡嗪控释片治疗。结果观察组治疗后FPG(5.6±0.6)mmol/L、P2 hPG(8.4±0.7)mmol/L、HbA1c(7.1±0.7)%、TC(4.1±0.6)mmol/L、TG(2.0±0.5)mmol/L、LDL(2.1±0.3)mmol/L、有效率96.7%、不良反应3.3%、并发症占3.3%。对照组治疗后FPG(8.1±0.4)mmol/L、P2 hPG(10.6±1.6)mmol/L、HbA1c(10.3±2.6)%、TC(5.6±0.8)mmol/L、TG(2.5±0.2)mmol/L、LDL(3.0±0.3)mmol/L、有效率70.0%、不良反应20.0%、并发症占23.3%。两组相比,差异有统计学意义(P<0.05)。结论采用格列吡嗪控释片治疗老年2型糖尿病,有效率高,不良反应少,可在降血糖的同时,实现对血脂水平的控制,预防并发症,改善预后。     

格列吡嗪控释片对老年2型糖尿病患者胰岛素敏感性的影响

本研究主要观察格列吡嗪控释片对 2型糖尿病患者胰岛素敏感性的影响。1　对象和方法1.1　对象　选择 1999年 6月～ 2 0 0 2年 3月在我院住院治疗的按 ADA标准确诊的 2型糖尿病患者 77例 ,男 45例 ,女 3 2例 ,年龄 60～ 72岁 ,病程 4～ 15年。其中并发冠心病 15例 ,脑梗死 11例 ,周围神经病变 18例 ,视网膜病变 9例 ,白内障 4例。患者均无急性并发症 ,观察期间均未用其他磺脲类药物或胰岛素治疗 ,只给予饮食治疗及口服二甲双胍和 /或拜糖平治疗。观察期间用药量不变。本组按照体重指数 (BMI)分为两组 :BMI<2 5者为 A组 ,BMI≥ 2 5者为 …     

控释格列吡嗪治疗2型糖尿病的效果及安全性

磺脲类口服降糖药自５０年代问世以来，被证明是对大多数２型糖尿病有效，且较为安全的药物。磺脲类主要的作用是刺激胰岛Ｂ细胞分泌胰岛素，多年来沿用的给药方法为餐前约３０分钟服用，日服２～３次。为了改进此类药物的给药方式，提高疗效、减轻副作用，近年开展了胃肠道治疗系统（ＧＩＴＳ）控释制剂的研究。首先研制成功用于临床的为格列吡嗪控释片。格列吡嗪为第二代磺脲类降糖药中疗效较高、副作用较少的品种。此药控释片日服１次，用于治疗２型糖尿病取得了良好的效果〔１～３〕，本文报道格列吡嗪控释片治疗２型糖尿病的效果及安全…     

利拉鲁肽治疗2型糖尿病的多中心临床研究

目的 研究利拉鲁肽单用或与二甲双胍、胰岛素促泌剂联用对中国2型糖尿病患者的有效性和安全性.方法 为多中心、自身对照、开放式临床研究,60例未接受药物治疗、114例已使用二甲双胍、46例已使用胰岛素促泌剂而血糖仍未达标的患者在原治疗基础上,联合利拉鲁肽0.6 mg降糖,并根据空腹血糖是否达标每2 周增加0.6 mg,最大剂量1.8 mg.治疗持续12周,观察治疗前、后血糖、体重等相关指标的变化.结果 利拉鲁肽治疗后,患者的平均空腹血糖下降(3.25±1.04)mmol/L,平均餐后血糖下降(4.97±2.35) mmol/L(P ＜0.01).平均糖化血红蛋白(Hb) Alc由治疗前的8.15％下降至7.00％,下降了1.15％;有88例(40.00％)及28例患者(12.73％)分别达到HbAlc＜7％及HbAlc ＜6.5％的控制目标.患者平均体重下降8 kg,其中约2/3体重下降5％以上,其余体重下降10％以上.体重下降幅度随基线体重指数(BMI)升高而明显升高,基线BMI越高体重下降越明显(x2=12.102,P=0.017).腰围由治疗前平均96.5 cm下降至89.0 cm(P＜0.01).同时患者平均收缩压及舒张压分别下降(5.26±3.11)及(3.10±2.05)mm Hg(1 mm Hg=0.133 kPa,P＜0.01).低血糖发生率为2.73％,且无严重低血糖事件发生.结论 在中国2型糖尿病患者中,应用利拉鲁肽单药治疗或与二甲双胍或胰岛素促泌剂联合治疗,可有效控制血糖、减轻体重、降低血压且低血糖风险小.     

格列吡嗪对2型糖尿病病人血清胰岛素样生长因子及其结合蛋白的影响

目的探讨格列吡嗪治疗对2型糖尿病病人血清胰岛素样生长因子（IGF）及其结合蛋白（IGFBP）的影响。方法采用病例对照及治疗前后自身对照研究,了解糖尿病病人空腹血清IGF-1、IGF-2和IGFBP-1、IGFBP-3水平及格列吡嗪治疗2周后的改变情况。其中糖尿病组40例,正常对照组90例,两组年龄无显著性差异,P＞0.05。结果与正常对照组比,糖尿病组治疗前IGF-1水平降低（234.41±141.78vs181.76±104.48ng/mlP＜0.05）,IGFBP-1水平升高(47.65±31.78vs68.82±43.18ng/ml,P＜0.01),IGF-2和IGFBP-3改变不明显。格列吡嗪治疗后IGF-I升高(181.8±104.5vs209.0±88.2ng/ml,P＜0.05);IGFBP-1则明显下降(68.82±43.18vs43.72±34.35ng/ml,p=0.001);IGF-II,IGFBP-3无明显变化。结论格列吡嗪治疗可改善2型糖尿病所导致的血清IGF-I和IGFBP-1水平改变。     

格列美脲联合门冬胰岛素30治疗2型糖尿病的多中心临床研究

目的 观察在接受门冬胰岛素30治疗控制不佳的2型糖尿病患者中,联合格列美脲治疗后胰岛素剂量和血糖水平的变化情况.方法 为多中心、开放、自身对照的观察性研究,入选161例2型糖尿病患者.在原门冬胰岛素30或联合2种以下非胰岛素促泌剂治疗方案基础上,联合格列美脲降糖治疗12周.结果 治疗3个胆后,患者全天各时点血糖均较基线...     

Metabolic and hemodynamic effects of sodium‐dependent glucose cotransporter 2 inhibitors on cardio‐renal protection in the treatment of patients with type 2 diabetes mellitus

The specific sodium–glucose cotransporter 2 inhibitors (SGLT2 inhibitors) inhibit glucose reabsorption in proximal renal tubular cells, and both fasting and postprandial glucose significantly decrease because of urinary glucose loss. As a result, pancreatic β‐cell function and peripheral insulin action significantly improve with relief from glucose toxicity. Furthermore, whole‐body energy metabolism changes to relative glucose deficiency and triggers increased lipolysis in fat cells, and fatty acid oxidation and then ketone body production in the liver during treatment with SGLT2 inhibitors. In addition, SGLT2 inhibitors have profound hemodynamic effects including diuresis, dehydration, weight loss and lowering blood pressure. The most recent findings on SGLT2 inhibitors come from results of the Empagliflozin, Cardiovascular Outcomes and Mortality in Type 2 Diabetes trial. SGLT2 inhibitors exert extremely unique and cardio‐renal protection through metabolic and hemodynamic effects, with long‐term durability on the reduction of blood glucose, bodyweight and blood pressure. Although a site of action of SGLT2 inhibitors is highly specific to inhibit renal glucose reabsorption, whole‐body energy metabolism, and hemodynamic and renal functions are profoundly modulated during the treatment of SGLT2 inhibitors. Previous studies suggest multifactorial clinical benefits and safety concerns of SGLT2 inhibitors. Although ambivalent clinical results of this drug are still under active discussion, the present review summarizes promising recent evidence on the cardio‐renal and metabolic benefits of SGLT2 inhibitors in the treatment of type 2 diabetes.     

Changes in carbohydrate metabolism in association with glipizide treatment of type 2 diabetes

Nineteen patients with Type 2 diabetes were treated with glipizide for 2.5-6 months, and measurements made of metabolic variables before and after glipizide treatment. For purposes of analysis, the glipizide associated decrease in fasting plasma glucose concentration was used to divide patients into 'good' responders (decrease of 4.0 mmol l-1 or more, n = 9) or 'fair' responders (decrease of 3.0 mmol l-1 or less, n = 10). Good responders had a significantly greater fall in their mean (+/- SE) hourly plasma glucose (6.3 +/- 0.6 vs 2.7 +/- 0.3 mmol l-1, p less than 0.001) and NEFA (164 +/- 40 vs 60 +/- 37 mumol l-1, p less than 0.05) concentrations from 0800 to 1600 h in response to meals (0800 and 1200 h) than did the fair responders. However, the increase in hourly plasma insulin concentration following glipizide treatment was the same in the good (323 +/- 103 to 413 +/- 124 pmol l-1) and fair (276 +/- 42 to 345 +/- 43 pmol l-1) responders.(ABSTRACT TRUNCATED AT 250 WORDS)     

Therapeutic adherence: A prospective drug utilization study of oral hypoglycemic in patients with type 2 diabetes mellitus

ObjectiveTo determine the drug utilization patterns and outcomes of treatment in terms of metabolic control in the type 2 diabetic patients on oral hypoglycemic agents in the outpatient department in the teaching hospital of Hamdard University, New Delhi, India.MethodsPatients with established type 2 diabetes (n=184) visiting the outpatient department were interviewed using a structured questionnaire over a period of five months.ResultsMajority of the type 2 diabetic patients in this setting were treated with a multiple oral hypoglycemic agents. The most commonly prescribed oral hypoglycemic agent was biguanides (metformin) followed by sulfonylureas (glimepiride), thiazolidinediones (pioglitazone), alpha-glucosidase inhibitors (miglitol) and dipeptidyl peptidase-4 inhibitors (vildagliptin). As monotherapy metformin was the most common choice followed by glimepiride and voglibose, the most prevalent multiple therapy was a three-drug combination of glimepiride + metformin + pioglitazone. The study showed poor compliance to the prescribed therapy.ConclusionsThis study prospected the need of patient education and counselled to enhance the patient compliance for prescribed oral hypoglycemic agents and concomitant drugs. There is need for diet control as well as blood glucose and HbA1c monitoring. Metabolic control was found to be poor in the study population. HbA1c monitoring was underutilized. Clinical monitoring of patient's adherence to the prescribed treatment to achieve good glycemic control is recommended. Measures should be taken to improve patient's adherence to the prescribed treatment.     

A comparative study of the clinical profile of fibrocalculous pancreatic diabetes and type 2 diabetes mellitus

AimsThe present study aimed to compare the clinical characteristics of patients with fibrocalculous pancreatic diabetes (FCPD) and those with type 2 diabetes mellitus (T2DM) to identify the characteristics distinctive of FCPD.MethodsA total of 133 patients with FCPD were compared with 665 patients with T2DM matched for duration of diabetes. Biochemical parameters and microvascular and macrovascular complications were assessed in all patients. Multivariate regression analyses were performed to study the determinants of microvascular and macrovascular complications in both groups.ResultsThe mean duration of diabetes was 4.42 ± 5.65 years in the FCPD group and 4.51 ± 3.88 years in the T2DM group. FCPD participants were significantly younger at diagnosis and leaner than patients with T2DM. The FCPD group had higher fasting and postprandial glucose and HbA1c levels than the T2DM group. The FCPD group had significantly lower triglyceride, total cholesterol, low-density lipoprotein cholesterol, serum total calcium, hemoglobin, and serum creatinine values than the T2DM group. The prevalence of coronary artery disease, stroke, and retinopathy was significantly higher in the T2DM patients while the prevalence of distal symmetric polyneuropathy was significantly lower. On multivariate logistic regression analysis, duration of diabetes and HbA1c (OR = 1.17, P = 0 0.04) in FCPD patients and age (OR = 1.04, P < 0 0.001), duration of diabetes (OR = 1.17, P < 0 0.001) and HbA1c (OR = 1.28, P < 0.001) in T2DM patients were associated with microvascular complications.ConclusionsThere are several differences in the phenotype, biochemical parameters, and prevalence of diabetic complications between patients with FCPD and T2DM. Timely diagnosis may have implications in the follow-up and management of patients.     

对2型糖尿病患者启动胰岛素治疗的思考

在2型糖尿病的治疗中尽早启动胰岛素治疗,是血糖达标的需要,也是保护胰岛β细胞、恢复其功能,从而延缓糖尿病进展的需要。初诊2型糖尿病患者经过3个月的生活方式干预和优化的口服降糖药物治疗血糖仍不能达标时,即应启动胰岛素治疗。对代谢紊乱严重、血糖水平较高的患者,应及时启动胰岛素强化治疗。可供选择的胰岛素治疗方案很多,各有优缺点和适应人群,临床上应当因患者而异地选择适宜的起始治疗方案。如何依据糖化血红蛋白（Hb）A1c选择起始治疗方案,目前尚无定论。推荐当HbA1c≤8．5％时主要选择基础胰岛素,HbA1c〉8．5％时选择预混胰岛素或基础—餐时或持续皮下胰岛素输注（CSII）作为起始胰岛素治疗方案。