小腿骨骼肌细胞内脂质的磁共振氢谱测定在2型糖尿病评估中的应用

目的:利用磁共振波谱成像技术(1Hmagneticresonancespectroscopy,1H-MRS),研究正常人与2型糖尿病患者的小腿骨骼肌肌细胞内脂质(intra-myocellularlipids,IMCL)含量,初步探讨IMCL水平与糖尿病的关系,为进一步明确IMCL与胰岛素抵抗机制奠定方法学基础。方法:对10例青年男性健康志愿者及29例初诊的2型糖尿病患者(男12例,女17例)进行了右侧小腿比目鱼肌1H-MRS测定,测量IMCL和肌酸及磷酸肌酸(Cr)波峰的峰高,计算IMCL相对于Cr的比值(IMCL/Cr)。正常组与糖尿病组分别测量了身高、体质量、血压、空腹及餐后2h血糖与胰岛素水平、血胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、糖化血红蛋白含量及腰臀比。结果:正常组与糖尿病组IMCL/Cr分别为1.64±0.54及2.75±0.86,两组间差异有显著性意义(t=3.76,P<0.001),而糖尿病组内男、女之间IMCL/Cr差异无显著性意义。糖尿病组IMCL/Cr与血糖、胰岛素、总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、糖化血红蛋白含量及腰臀比无关。结论:对IMCL水平的测定可作为胰岛素敏感性的检测指标。     

小腿骨骼肌细胞内脂质的磁共振氢谱测定在2型糖尿病评估中的应用

目的：利用磁共振波谱成像技术(^1H magnetic resonance spectroscopv，^1H—MRS)，研究正常人与2型糖尿病患者的小腿骨骼肌肌细胞内脂质(intra-myocellular lipids，IMCL)含量，初步探讨IMCL水平与糖尿病的关系，为进一步明确IMCL与胰岛素抵抗机制奠定方法学基础。方法：对10例青年男性健康志愿者及29例初诊的2型糖尿病患者(男12例，女17例)进行了右侧小腿比目鱼肌^1H-MRS测定，测量IMCL和肌酸及磷酸肌酸(Cr)波峰的峰高，计算IMCL相对于Cr的比值(IMCL／Cr)。正常组与糖尿病组分别测量了身高、体质量、血压、空腹及餐后2h血糖与胰岛素水平、血胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、糖化血红蛋白含量及腰臀比。     

健康青年志愿者比目鱼肌细胞内外脂质的1H-MRS可重复性研究

目的 评价健康青年人比目鱼肌细胞内外脂质的1H-MRS的可重复性.方法 对10名健康青年志愿者右腿比目鱼肌行1H-MRS检查,每位志愿者接受3次检查,每两次间隔2周.采用SAGE软件量化细胞内脂质峰(SIMCL)和细胞外脂质峰(SEMCI),然后分析不同时间和不同个体的差异性及相关性.结果 成功采集30个体素的1H-MRS谱线.IMCL峰下面积均值为0.57±0.1 6,EMCL峰下面积均值为1.02±0.21.IMCL的三次检查间无显著差异(F=2.262,P=0.133),但有相关性(r1-2=0.986,r2-3=0.985,r1-3=0.991,P<0.05).不同个体间IMCL有显著差异(F=216.315,P<0.05),IMCL与体重有明显相关性(r=0.717,P<0.05).EMCL在不同时间和不同个体之间均无显著差异及相关性.IMCL与EMCL间无相关性.结论 IMCL峰是标识不同个体差异的重要峰,在一定的时间范围内具有可重复性.     

高血脂肥胖人群和2型糖尿病患者胰岛素抵抗与胰岛素分泌指数变化及临床意义

目的探讨高血脂肥胖人群和2型糖尿病患者胰岛素抵抗与胰岛素分泌功能变化及临床价值。方法测定正常对照组,高血脂肥胖组和2型糖尿病组,空腹血糖和空腹胰岛素含量,计算稳态模式评估法胰岛素抵抗指数(HOMA-IR)和胰岛素分泌指数(HOMA-β)。结果2型糖尿病组和高血脂肥胖组HOMR-IR指数均明显高于正常对照组(P<0.01),且2型糖尿病组又明显高于高血脂肥胖组(P<0.01);2型糖尿病组HOMA-β指数明显低于正常对照组(P<0.01),高血脂肥胖组HOMA-β指数明显高于正常对照组(P<0.01)。结论胰岛素相对血糖分泌功能下降伴随胰岛素抵抗加重,在2型糖尿病发生发展中起重要作用。高血脂肥胖人群代偿性胰岛素抵抗应引起高度重视。     

高血脂肥胖人群和2型糖尿病患者胰岛素抵抗与胰岛素分泌指数变化及临床意义

目的探讨高血脂肥胖人群和2型糖尿病患者胰岛素抵抗与胰岛素分泌功能变化及临床价值.方法测定正常对照组,高血脂肥胖组和2型糖尿病组,空腹血糖和空腹胰岛素含量,计算稳态模式评估法胰岛素抵抗指数(HOMA-IR)和胰岛素分泌指数(HOMA-β).结果2型糖尿病组和高血脂肥胖组HOMR-IR指数均明显高于正常对照组(P＜0.01),且2型糖尿病组又明显高于高血脂肥胖组(P＜0.01);2型糖尿病组HOMA-β指数明显低于正常对照组(P＜0.01),高血脂肥胖组HOMA-β指数明显高于正常对照组(P＜0.01).结论胰岛素相对血糖分泌功能下降伴随胰岛素抵抗加重,在2型糖尿病发生发展中起重要作用.高血脂肥胖人群代偿性胰岛素抵抗应引起高度重视.     

血清小而密低密度脂蛋白胆固醇与2型糖尿病患者胰岛素抵抗的相关性分析

目的探讨2型糖尿病患者血清小而密低密度脂蛋白胆固醇(sdLDL-C)与胰岛素抵抗的相关性。方法依据糖尿病诊断和分类标准将受试者分为三组,分别为正常糖代谢(NGT)组150例、糖耐量异常(IGT)组138例和2型糖尿病(T2DM)组152例。比较三组受试者的一般资料、脂质代谢和糖代谢水平。分析脂质代谢与糖代谢指标的相关性。通过多重线性回归分析,探讨胰岛素抵抗的相关影响因素。结果 NGT组、IGT组和T2DM组受试者的体质指数(BMI)、腰臀比(WHR)、总甘油三酯(TG)、sdLDL-C、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)和胰岛素抵抗指数(HOMA-IR)呈逐渐升高的趋势。sdLDL-C与FBG、HbA1c、FINS和HOMA-IR等指标存在显著相关性。多重线性回归分析结果表明,BMI、WHR、TG、sdLDL-C对HOMA-IR影响最大。结论 sdLDL-C与2型糖尿病患者胰岛素抵抗密切相关。     

2型糖尿病合并高血压患者血浆内皮素水平的变化

目的:讨论糖尿病患者内皮素与血压、体重指数(BMI)、胰岛素抵抗指数(HOMA-IR)的关系。方法:2型糖尿病患者分高血压组、对照组,测定内皮素、胰岛素、血糖、BMI、HOMA-IR等。结果:高血压组内皮素、BMI、HOMA-IR较对照组升高。HOMA-IR、BMI、血压与内皮素呈正相关。结论:高血压、肥胖、胰岛素抵抗促进糖尿病患者内皮素升高,加重内皮细胞功能损害。     

2型糖尿病患者血管内皮舒张功能的超声评价

目的 采用超声检测2型糖尿病患者的血管内皮舒张功能,探讨胰岛素抵抗和分泌功能对血管内皮功能的影响.方法 将45例2型糖尿病患者分为高胰岛素血症组(HI组)和非高胰岛素血症组(NHI组),选取健康体检者为对照组,应用超声检测肱动脉内皮依赖性舒张功能(EDD)和非依赖性舒张功能(EID),测定空腹血糖、空腹胰岛素及一氧化氮,采用稳态模式法评估胰岛素抵抗指数(HOMA-IR)和胰岛素分泌指数(HOMA-β);2组糖尿病患者各指标与对照组进行两两比较.结果 糖尿病患者的EDD、EID及一氧化氮明显低于对照组(P＜0.01);HI组与NHI组比较,EDD、EID及一氧化氮明显降低,HOMA-IR、HOMA-β明显升高(P＜0.01),糖尿病患者的EDD、EID均与空腹胰岛素、HOMA-IR呈显著负相关(P＜0.01).结论 2型糖尿病患者的血管EDD和EID均有受损,高胰岛素血症和胰岛素抵抗是导致血管损害加重的高度危险因素.     

针灸治疗磺脲类药物继发性失效的疗效观察

目的 探讨2型糖尿病患者对磺脲类药物继发性失效的治疗方法.方法 将对磺脲类药物继发性失效的2型糖尿病患者75例,分为针灸组,安慰剂组.观察FPG、2 hPG、HbAlc、胰岛素抵抗指数(HOMA-IR)、胰岛B细胞功能指数(HOMA-B)的改变.结果 针灸组的观察指标均有明显的改善.结论 针灸治疗磺脲类药物继发性失效安全、有效、经济、相对方便.     

老年糖尿病患者认知功能障碍与胰岛素抵抗的关系及护理分析

目的 探讨老年糖尿病患者认知功能障碍与体重指数、胰岛素抵抗指数的相关性及护理分析.方法 以60例老年糖尿病患者作为研究对象,根据简易精神状态量表(MMSE)分为糖尿病组(MMSD24),糖尿病合并痴呆组(MMSE≤24),另以24例非糖尿病老年患者作为对照组,分别检测体重指数(BMl)、糖化血红蛋白(HBAlC)及胰岛素抵抗指数(HOMA-IR,空腹血糖×空腹胰岛素/22.5).结果 与糖尿病组及对照组相比,糖尿病合并痴呆患者的HOMA-IR、HBAlC及BMI显著增加(P＜0.05),糖尿病患者的认知功能与HOMA-IR、HBAlC及BMI呈负相关.结论 对存在胰岛素抵抗、肥胖的老年糖尿病患者加强预防痴呆的护理,可防止或延缓认知功能障碍.     

大鼠骨骼肌脂肪含量的1H-MRS定量分析和病理对照研究

目的研究1H-MRS在肌肉脂肪含量的定量分析中的价值及与病理分级的相关性。方法使用GE1.5TMR扫描机及正交birdcage动物线圈(50mm),对28只成年Wistar大鼠左侧后肢比目鱼肌进行1H-MRS采集。采集到的波谱使用SAGE软件进行后处理,分析细胞内脂肪和细胞外脂肪含量。使用电镜观察肌肉细胞内的脂滴含量。结果全部大鼠均成功采集肌肉波谱。所有谱线均可以解析位于3.02～3.05ppm处的总胆碱,1.3ppm处的肌肉细胞内脂肪和1.5ppm处的肌肉细胞外脂肪。大鼠肌肉细胞内脂肪含量/总胆碱比值为0.58～5.72,与电镜下观察到的细胞内脂肪的含量呈正比(r=0.952,P<0.001)。结论使用1H-MRS可以准确、无创测量肌肉细胞内的脂肪含量,且与病理检查结果一致。     

Homeostasis model assessment is a reliable indicator of insulin resistance during follow-up of patients with type 2 diabetes

OBJECTIVE: To investigate the usefulness of the homeostasis model assessment as an index of insulin resistance (HOMA-IR) for evaluating the clinical course of patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: The usefulness of HOMA-IR and its relationship with insulin resistance assessed by the hyperinsulinemic-euglycemic clamp study (clamp IR) were evaluated in 55 Japanese patients with type 2 diabetes before and after treatment. The patients were subjected to diet (approximately 1,440-1,720 kcal/day) and exercise therapy (walking 10,000 steps daily) for 6 weeks during their hospitalization. RESULTS: Univariate regression analysis disclosed a significant correlation between log-transformed HOMA-IR and log-transformed clamp IR before (r = -0.613, P < 0.0001) and after ( = -0.734, P < 0.0001) treatment. Neither the slopes (-0.71 +/- 0.12 vs. -0.79 +/- 0.09, F = 0.25, P = 0.61) nor the intercepts (y-intercept = 1.67 vs. 1.70, x-intercept = 2.36 vs. 2.15, F = 0.02, P = 0.88) of the regression lines between HOMA-IR and clamp IR were significantly different before and after treatment. There was a significant correlation between the decrease in log-transformed HOMA-IR and the increase in clamp IR during treatment (r = -0.617, P < 0.0001). CONCLUSIONS: HOMA-IR may constitute a useful method not only for diagnosing insulin resistance, but also for follow-up during the treatment of patients with type 2 diabetes.     

The mushroom Agaricus Blazei Murill in combination with metformin and gliclazide improves insulin resistance in type 2 diabetes: a randomized, double-blinded, and placebo-controlled clinical trial

BACKGROUND: Complementary and alternative medicine use in adults with type 2 diabetes is popular. Although most of the herbs and supplements appear to be safe, there is still insufficient evidence that demonstrates their definitive beneficial effects. This study was done to determine whether the supplement of Agaricus blazei Murill extract improves insulin resistance in type 2 diabetes. MATERIALS AND METHODS: This study was a clinical randomized, double-blind, placebo-controlled trial. Of a population of 536 registered diabetes patients with 72 subjects (1) aged between 20 and 75 years, (2) being Chinese, (3) having type 2 diabetes for more than 1 year, and (4) having been taking gliclazide and metformin for more than 6 months were enrolled in this study. The enrolled patients were randomly assigned to either receiving supplement of Agaricus blazei Murill (ABM) extract or placebo (cellulose) 1500 mg daily for 12 weeks. Homeostasis model assessment for insulin resistance (HOMA-IR) was used as the major outcome measurement. RESULTS: At the end of the study, subjects who received supplement of ABM extract (n = 29) showed significantly lower HOMA-IR index (3.6[standard deviation, 2.5] versus 6.6[standard deviation, 7.4], p = 0.04) than the control group (n = 31). The plasma adiponectin concentration increased 20.0(standard deviation, 40.7)% in the ABM group after 12 weeks of treatment, but decreased 12.0(20.0)% among those taking the placebo (p < 0.001). CONCLUSIONS: Supplement of ABM extract improves insulin resistance among subjects with type 2 diabetes. The increase in adiponectin concentration after taking AMB extract for 12 weeks might be the mechanism that brings the beneficial effect. Studies with longer periods of follow-up should be conducted in the future.     

菊粉和金玉兰对2型糖尿病患者血糖控制和血脂代谢的影响

  目的  研究菊粉和金玉兰对2型糖尿病患者血糖控制和血脂代谢的影响。  方法  75例2型糖尿病患者按照性别和体重指数匹配的方法分为菊粉组(n=25)、金玉兰组(n=25)和对照组(n=25), 3组患者均给予普通糖尿病膳食, 在此基础上菊粉组每天给予菊粉15 g, 金玉兰组每天给予金玉兰120 g。分别于基线期、4和8周时观察3组患者的空腹血糖(fasting blood glucose, FBG)、胰岛素抵抗指数(homeostasis model assessment of insulin resistance index, HOMA-IR)、糖化血红蛋白(glycated hemoglobin, HbA1c)、血脂、转氨酶和肌酐等指标的变化并进行比较。  结果  菊粉组、金玉兰组及对照组分别有23、22和23例完成研究。基线期各项观察指标3组之间差异均无统计学意义(P > 0.05)。4周时, 菊粉组FBG、HbA1c、HOMA-IR、总胆固醇(total cholesterol, TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-c)的变化同对照组相比有降低的趋势; 8周时, 菊粉组FBG、HbA1c、HOMA-IR、TC、LDL-c的降低同对照组相比差异具有统计学意义(P < 0.05), 其余观察指标变化的差异无统计学意义(P > 0.05)。4周和8周时, 金玉兰组各项指标变化同对照组相比差异无统计学意义(P > 0.05)。  结论  菊粉有益于2型糖尿病患者的血糖控制和血脂代谢, 并且对肝、肾功能无影响。金玉兰对2型糖尿病患者血糖控制和血脂代谢无显著影响。     

初诊2型糖尿病患者TLR4水平与糖脂代谢及慢性炎症的相关性

目的:探讨初诊2型糖尿病患者血清Toll样受体4(Toll-like receptor 4,TLR4)水平变化及其与糖脂代谢和慢性炎症的相关性。方法:选取2018年9月至2019年1月于吉林大学第二医院内分泌科就诊的150例初诊2型糖尿病患者及45例正常体检人员,将所选研究对象分为正常对照组(NC组,n=45),2型糖尿病组(T2DM组,n=85),2型糖尿病合并超重或肥胖组(T2DM+OB组,n=65)。统计并检测各组年龄,性别,病程,BMI,三酰甘油(triglyceride,TG),总胆固醇(total cholesterol,TC),高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C),低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C),空腹血糖(fasting plasma glucose,FPG),糖化血红蛋白(glycosylated hemoglobin,HbA1c),空腹胰岛素(fasting insulin,FINS),稳态胰岛素评价指数(homeostasis modeall assessment of insulin resistance,HOMA-IR),超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)。ELISA检测血清TLR4水平。3组间比较采用方差分析;应用Pearson相关分析血清TLR4与BMI,TG,LDL-C,HOMA-IR,hs-CRP的相关性;logistic回归分析2型糖尿病合并超重或肥胖的独立危险因素等。结果:NC组、T2DM组、T2DM+OB组的TG,LDL-C,FPG,HbA1c,FINS,HOMA-IR,hs-CRP,TLR4水平逐渐升高,3组间差异有统计学意义(P<0.05)。相关性分析显示:血清TLR4水平与BMI,TG,LDL-C,HOMA-IR及hs-CRP呈正相关。Logistic回归分析显示:LDL-C,HOMA-IR,hs-CRP,TLR4是2型糖尿病合并肥胖或超重的独立危险因素。结论:初诊2型糖尿病患者血清TLR4水平升高,其合并超重或肥胖的风险越大。     

The effect of insulin antibodies on the metabolic action of inhaled and subcutaneous insulin: a prospective randomized pharmacodynamic study

OBJECTIVE: To assess the impact of the development of high- or low-affinity insulin antibodies (IABs) on postprandial glucose tolerance, duration of insulin action, and clinical safety in patients with type 1 diabetes receiving inhaled insulin (Exubera). RESEARCH DESIGN AND METHODS: This study consisted of a prospective, randomized, open-label, parallel-group trial in which 47 patients with type 1 diabetes received NPH insulin twice daily plus either premeal inhaled insulin (INH group; n = 24) or pre-meal subcutaneous regular insulin (SC group; n = 23) for 24 weeks. Meal challenge and euglycemic clamp studies were performed on consecutive days at baseline, week 12, and week 24. Adverse events were monitored. RESULTS: For the INH and SC groups, mean (+/-SD) IAB levels were 3.5 +/- 3.9 and 2.6 +/- 4.1 muU/ml at baseline, respectively, compared with 101.4 +/- 140.4 and 4.3 +/- 9.4 microU/ml at week 24. At week 24, the changes from baseline were similar for the INH and SC groups for maximal plasma glucose concentration (C(max)) (adjusted ratio for treatment group difference 0.99 [90% CI 0.95-1.03]), area under the plasma glucose concentration time curve (adjusted ratio for treatment group difference 0.98 [0.88-1.08]), and duration of insulin action (adjusted treatment group difference 29 min [-49 to 108]). No adverse events were attributed to IABs. CONCLUSIONS: In patients with type 1 diabetes treated with inhaled insulin, development of high- or low-affinity IABs did not impair postprandial glucose tolerance, alter the time-action profile of insulin, or impact tolerability. No clinical relevance of IABs was identified in this study.     

Biological variation of homeostasis model assessment-derived insulin resistance in type 2 diabetes

OBJECTIVE: Individuals with type 2 diabetes are particularly vulnerable to cardiovascular disease. Insulin resistance is a major determinant of this increased risk and is a potential therapeutic target. This study was undertaken to establish the natural biological variation of insulin resistance in individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS: The biological variation of insulin resistance was assessed by measuring insulin resistance at 4-day intervals on 10 consecutive occasions in 12 postmenopausal women with diet-controlled type 2 diabetes and in 11 weight- and age-matched postmenopausal women without type 2 diabetes. Insulin resistance was derived using the homeostasis model assessment for insulin resistance (HOMA-IR) method. RESULTS: The distribution of HOMA-IR was log Gaussian in the type 2 diabetic study group and Gaussian in the control group. The HOMA-IR in the type 2 diabetic group was significantly greater than that of the control group (mean +/- SD: 4.33 +/- 2.3 vs. 2.11 +/- 0.79 units, P = 0.001). After accounting for analytical variation, the mean intraindividual variation was also substantially greater in the type 2 diabetic group than in the control group (mean 1.05 vs. 0.15, P = 0.001). Consequently, at any level of HOMA-IR, a subsequent sample must increase by >90% or decrease by >47% to be considered significantly different from the first. CONCLUSIONS: HOMA-IR is significantly greater and more variable for individuals with type 2 diabetes. Therefore, this inherent variability needs to be accounted for in studies evaluating therapeutic reduction of HOMA-IR in this group.     

瘦素与2型糖尿病的关系

目的　观察瘦素与体重指数、腰围、臀围及糖代谢指标间的相关性,探讨瘦素与2型糖尿病的关系。方法　将6 4例2型糖尿病患者按体重指数分为非肥胖组及肥胖组,并将6 7例正常对照组亦按体重指数分为健康对照组及单纯肥胖组,测定体重指数、腰围、臀围及糖代谢指标、瘦素等,以胰岛素抵抗指数(HOMA- IR)来评价胰岛素的敏感性。应用SPSS10 .0软件统计分析。结果　①2型糖尿病者的血清瘦素水平及HOMA -IR均高于对照组(P <0 .0 5 ) ;肥胖者的瘦素水平及HOMA -IR均高于非肥胖者(P <0 .0 5 ) ;②Logistic多元回归显示:HOMA- IR(OR =10 6 .6 96 )、瘦素(OR =6 .86 3)是2型糖尿病的危险因素。结论　瘦素抵抗与胰岛素抵抗及2型糖尿病的发生相关。     

胰岛素强化治疗对改善初诊2型糖尿病患者胰岛素抵抗的疗效分析

目的 评价三种短期胰岛素强化治疗改善不同胰岛素抵抗状态初诊2型糖尿病(T2DM)患者胰岛β细胞功能的效果.方法 初诊T2DM患者98例,分为存在胰岛素抵抗(IR)组(HOMA-IR≥5)和不存在胰岛素抵抗(Non-IR)组(HOMA-IR＜5);分别接受持续胰岛素皮下输注(CSⅡ)、门冬胰岛素加甘精胰岛素(glar)、门冬胰岛素30注射液(aspart 30)强化治疗,IR-CSⅡ组20例,IR-glar组22例,IR-aspart 30组23例;Non-IR-CSⅡ组10例,Non-IR-glar组12例,Non-IR-aspart 30组11例.测定6组治疗2周前后空腹血糖(FPG)、空腹C肽(C-P)、餐后2 h血糖(2 hPG),采用空腹C-P水平计算β细胞功能指数[HOMA-islet(C-P)]和胰岛素抵抗指数[HOMA-IR(C-P)].结果血糖达标时间、胰岛素用量、低血糖发生频率在CSⅡ组少于glar组和aspart 30组(P＜0.05或＜0.01),glar组与aspart 30组比较差异无统计学意义(P均＞0.05).达标时Non-IR组胰岛素日用量低于同种治疗方式的IR组(P均＜0.01),△HOMA-islet(C-P)高于IR组(P均＜0.05),△HOMA-IR(C-P)低于IR组(P＜0.05);CSⅡ组△HOMA-IR(C-P)(IR组1.79±0.15,Non-IR组1.51±0.09)和△HOMA-islet(C-P)(IR组4.01±0.21,Non-IR组4.35±0.23)高于glar组(IR组1.63±0.21、3.86±0.12,Non-IR组1.40±0.19、4.03±0.18)和aspart 30组(IR组1.61±0.13、3.88±0.32,Non-IR组1.42±0.11、4.01±0.14,P＜0.05或＜0.01).结论 三种胰岛素强化治疗方式均可改善伴有高血糖的初诊2型糖尿病患者胰岛β细胞功能,减轻胰岛素抵抗,尤以CSⅡ效果更好.但有明显胰岛素抵抗的患者治疗效果欠佳.     

西格列汀与格列齐特缓释片联用甘精胰岛素治疗2型糖尿病的疗效与安全性评价

目的 对西格列汀与格列齐特缓释片联合甘精胰岛素治疗2型糖尿病(T2DM)的疗效和安全性进行比较。方法 以83例T2DM患者为研究对象,按照随机数字表法分为观察组与对照组。观察组使用西格列汀联合甘精胰岛素的用药方案,对照组使用格列齐特缓释片联合甘精胰岛素的用药方案。均治疗16周,监测治疗前后空腹血糖(FPG)、餐后2 h血糖(2h PG)、糖化血红蛋白(Hb A1c)、空腹胰岛素水平(FIns)、胰岛素抵抗指数(HOMA-IR)、体质量指数(BMI)等指标以及胰岛素用量、不良反应的发生情况。结果 治疗后两组的血糖控制均改善,FPG、2h PG、Hb A1c、HOMA-IR水平较治疗前均明显下降,FIns均明显升高(P0.05)。治疗后水平比较,对照组FPG降低较观察组明显(P0.05),但是观察组2h PG降低更明显(P0.05);Hb A1c达标率、HOMA-IR两组间前后差值比较,差异无统计学意义(P0.05)。观察组的BMI水平较对照组下降了6.25%,胰岛素用量减少了12.92%,差异有统计学意义(P0.05)。安全性方面,观察组低血糖的发生率(2.38%),与对照组(9.76%)比较,差异有统计学意义(P0.05)。结论 西格列汀联用甘精胰岛素治疗2型糖尿病使血糖控制良好,安全性高。