口服降糖药联合甘精胰岛素治疗2型糖尿病的临床观察

目的：对口服降糖药联合甘精胰岛素治疗2型糖尿病的临床效果进行观察。方法将本院收治的86例2型糖尿病患者纳入研究,根据患者将其分为观察组与参考组,各为43例,观察组采用降糖药治疗联合甘精胰岛素治疗,参考组单纯采用口服降糖药物治疗,比较治疗前、治疗3个月后两组患者空腹血糖、餐后2h血糖、糖化血红蛋白变化及并发症发生情况。结果治疗3个月后两组患者空腹血糖、餐后2 h血糖及糖化血红蛋白含量均出现明显下降（P〈0.05）;观察组血糖控制情况明显优于参考组（P〈0.05）;观察组并发症发生率明显低于参考组（P〈0.05）。结论口服降糖药联合甘精胰岛素治疗2型糖尿病控制血糖效果显著,减少并发症发生。     

早期胰岛素强化治疗2型糖尿病治疗分析

目的 探讨早期胰岛素强化治疗2型糖尿病的疗效.方法 新诊断的2型糖尿病患者80例,随机分为胰岛素强化组(治疗组)40例; 口服降糖药物组(对照组)40例,疗程8周,观察两组治疗前后空腹血糖、餐后2 h血糖、糖化血红蛋白、糖化血清蛋白、空腹C肽、体重指数指标的变化.结果 胰岛素强化组治疗后空腹血糖、餐后2 h血糖控制满意,糖化血红蛋白及糖化血清蛋白和体重指数下降,空腹 c肽水平升高,而且脱离胰岛素治疗后监测血糖控制满意.口服降糖药物组空腹血糖等各项检测指标有改善,但与治疗组比较均有统计学差异(P<0.01).结论 2型糖尿病患者早期胰岛素强化治疗能更有效地控制血糖水平,降低高糖毒性,减轻胰岛素抵抗,使胰岛β细胞功能得到改善,能延缓糖尿病自然病程的进程.     

甘精胰岛素联合二甲双胍治疗2型糖尿病的疗效观察

目的:探讨对于2型糖尿病口服降糖药物血糖控制差,改为甘精胰岛素注射液联合二甲双胍片降糖的疗效.方法:收集2014年1月~2016年1月在我院内分泌科住院治疗2型糖尿病患者80例,因口服降糖药物血糖控制差,分为甘精胰岛素组(A组)40例,预混胰岛素治疗组(B组)40例,A组采用甘精胰岛素针联合二甲双胍降糖治疗,B组采用预混胰岛素针降糖治疗,观察甘精胰岛素组与预混胰岛素组治疗前后血糖的变化、血糖达标时间、胰岛素用量及低血糖发生率.结论:甘精胰岛素针联合二甲双胍片治疗2型糖尿病血糖控制平稳,低血糖发生率低,甘精胰岛素联合二甲双胍片对口服药物血糖控制差的2型糖尿病患者是首选治疗方法.     

甘精胰岛素联合阿卡波糖治疗2型糖尿病的疗效观察

目的探讨对于口服降糖药物不能很好控制血糖的2型糖尿病(T2DM)患者,改为甘精胰岛素针联合阿卡波糖片治疗的临床疗效。方法收集口服降糖药物控制不佳的2型糖尿病患者共60例,分为甘精胰岛素治疗组(A组)及预混胰岛素针治疗组(B组)各30例,A组采用甘精胰岛素针联合阿卡波糖治疗,B组采用预混胰岛素针单用治疗,观察两种方法治疗前后血糖的变化、胰岛素用量、血糖达标时间、低血糖发生率。结果两组患者经治疗后血糖均明显下降。A组与B相比较血糖更加容易平稳,血糖达标时间短,胰岛素用量偏少,低血糖发生率低,差异具有统计学意义(P<0.05)。结论甘精胰岛素针联合阿卡波糖片治疗T2DM疗效安全有效,适宜作为口服降糖药物不能良好控制的2型糖尿病患者的首选治疗方法。     

地特胰岛素治疗2型糖尿病的临床观察

良好的血糖控制可降低糖尿病相关并发症的风险。随着疾病进展,2型糖尿病患者需在口服降糖药物基础上联合胰岛素治疗,以使血糖控制达标。而在口服降糖药物基础上增加基础胰岛素治疗,是2型糖尿病患者起始应用胰岛素治疗的一种有效选择,传统的基础人胰岛素诺和灵N(NPH),多年来在临     

胰岛素治疗2型糖尿病患者的疗效观察

目的观察应用胰岛素对2型糖尿病的降血糖作用。方法将确诊为2型糖尿病患者28例,随机分为胰岛素治疗组（治疗组）和口服降血糖药治疗组（对照组）。治疗半年后观察两组空腹血糖（FPG）、餐后2h血糖（2hPG）及糖化血红蛋白（HbA1c）。结果治疗组与对照组相比较,治疗组FPG、2hPG较对照组控制好,HbA1c均控制在〈7%。结论对2型糖尿病患者早期应用胰岛素,尤其是病程长、药物控制效果差的患者,疗效更佳,而且减少并发症的发生。     

胰岛素全程治疗糖尿病合并肺结核的疗效分析

目的 探讨胰岛素全程治疗糖尿病合并肺结核患者的疗效和安全性.方法 100例2型糖尿病（T2DM）合并肺结核患者在常规应用抗结核药物治疗的同时,随机分为胰岛素（门冬胰岛素30注射液）治疗（观察组52例）和口服降糖药治疗（对照组48例）,比较治疗后两组的血糖达标时间、低血糖发生率、痰菌转阴情况及肺结核病灶X线变化.结果 治疗观察组的临床症状改善、胸片转归及血糖达标时间明显优于对照组.结论 糖尿病合并肺结核患者降糖首选方案为胰岛素（门冬胰岛素30注射液）全程控制血糖,而肺结核化疗疗效与血糖控制水平密切相关.     

甘精胰岛素联合二甲双胍治疗2型糖尿病的疗效观察

目的探讨对于口服降糖药物不能很好控制血糖的2型糖尿病(T2DM)患者,改为甘精胰岛素针联合二甲双胍片治疗的临床疗效。方法收集2010年1月至2011年10月期间我院收治的口服降糖药物控制不佳的2型糖尿病患者共60例,分为甘精胰岛素治疗组(A组)及预混胰岛素针治疗组(B组)各30例,A组采用甘精胰岛素针联合二甲双胍片治疗,B组采用预混胰岛素针单用治疗,观察两种方法治疗前后血糖的变化、胰岛素用量、血糖达标时间、低血糖发生率。结果两组患者经治疗后血糖均明显下降。A组与B相比较血糖更加容易平稳,血糖达标时间短,胰岛素用量偏少,低血糖发生率低,并且部分患者有体质量减轻,差异具有统计学意义。结论甘精胰岛素针联合二甲双胍片治疗T2DM疗效安全有效,适宜作为口服降糖药物不能良好控制的2型糖尿病患者的首选治疗方法。     

精蛋白锌重组人胰岛素混合注射液治疗2型糖尿病患者31例

目的研究精蛋白锌重组人胰岛素混合注射液对2型糖尿病患者的疗效影响及并发症发生率。方法采用随机数字表法将62例患者随机分为观察组和对照组,各31例。对照组采用降糖药物治疗,观察组采用胰岛素联合降糖药物治疗,比较两组患者血糖控制效果、治疗依从性、药物不良反应发生率和糖尿病并发症发生率。结果观察组患者空腹血糖为（7．07±0．25）mmol／L,餐后2h血糖（8．43±0．37）mmol／L,糖化血红蛋白（6．92±0．44）％,对照组分别为（7．34±0．30）mmol／L,（9．12±0．48）mmol／L,（7．29±0．54）％,组间比较差异具有统计学意义（P〈0．05）。观察组患者糖尿病急性并发症发生率为16．13％,慢性并发症发生率为9．68％;对照组患者分别为38．71％和29．03％,组间比较差异具有统计学意义（P〈0．05）。结论精蛋白锌重组人胰岛素混合注射液有助于患者血糖控制,可有效降低药物不良反应和糖尿病并发症发生率。     

初诊2型糖尿病患者短期胰岛素强化治疗的临床研究

目的观察短期胰岛素强化治疗初诊的2型糖尿病患者的疗效。方法将新诊断的2型糖尿病患者138例随机分为2组,观察组78例予胰岛素强化治疗,对照组60例给予口服降糖药物治疗,比较2组治疗前后空腹血糖（FPG）、餐后血糖（2hPG）、糖化血红蛋白（HbA1c）、空腹胰岛素（FINS）、C-肽（C-P）、胰岛素抵抗指数（HOMA-IR）和胰岛素分泌指数（HOMA-β）。结果治疗后2组的FPG、2hPG、HbA1c、FINS、C-P、HOMA-IR、HOMA-β各项指标均较治疗前有所改善（P〈0.05）;且治疗组PFG、2hPG、HOMA-IR下降指数较对照组明显,FINS、C-P、HOMA-β升高指数较对照组明显,2组差异有统计学意义（P〈0.05）。结论初诊的2型糖尿病患者予短期胰岛素强化治疗有利于改善血糖和胰岛功能。     

罗格列酮安全性再评价:一项基于随机对照研究、队列研究、病例对照研究及病例报告的系统评价

目的：评价与其他抗糖尿病口服药物相比,罗格列酮治疗2型糖尿病患者的安全性。方法：按照检索策略在EMbase、MEDLINE、The Cochrane library等6个数据库中进行电子检索,并人工进行补充检索。按纳入排除标准进行筛选,对纳入文献进行偏倚风险评估,并使用Revman 5.3软件进行统计学Meta分析。结果：共纳入63篇研究,其中随机对照试验17篇。研究结果显示,罗格列酮组的总不良反应发生率与其他口服糖尿病药物相比无显著差异,然而RCT研究结果提示罗格列酮组因不良反应退出的比例高于非TZD类药物组,但低于吡格列酮组。对于心脑血管不良反应发生率,RCT研究和队列研究结果都支持罗格列酮与其他糖尿病药物相比无统计学意义,但病例对照研究结果认为罗格列酮暴露组心脑血管不良反应发生率高于未暴露组。罗格列酮组的低血糖发生率与二甲双胍组无显著差异,且低于磺脲类。RCT研究结果提示罗格列酮组体质量升高的患者比例和水肿发生率高于其他口服降糖药。队列研究结果显示罗格列酮组的骨折发生率高于其他药物,但低于吡格列酮。对于膀胱癌的发病率,队列研究结果显示罗格列酮组发病率低于吡格列酮组以及其他非TZD类糖尿病药物组,而病例对照研究却得到了相反的结果。结论：应用罗格列酮治疗2型糖尿病,总体不良反应发生率不高于其他口服降糖药,且尚无确切证据证明该药致心脑血管事件的风险高于其他抗糖尿病药物,但应对其水肿、体质量增加、骨折的风险加以预防,并警惕其致肿瘤风险。     

我院2006-2009年口服抗糖尿病药物应用分析

目的了解该院口服抗糖尿病药物的应用现状和发展趋势。方法对该院口服抗糖尿病药物的主要品种、用药金额、用药频度、限定日费用等进行统计和分析。结果该院口服抗糖尿病药物2009年用药金额是2006年的1.21倍,呈上升趋势。磺酰脲类药物在几年中的构成比居首位。最常用的口服降糖药是二甲双胍、格列吡嗪和瑞格列奈。瑞格列奈、阿卡波糖、吡格列酮用药频度上升较大。结论口服抗糖尿病药物在2型糖尿病治疗中应用合理,需求量逐年增加。安全、有效、依从性好、价格适中是糖尿病治疗药物发展的必然趋势。     

临床药师干预对高血压患者药物使用合理率的影响

目的:探索临床药师参与临床治疗团队,对药物使用合理率的影响。方法:将我院2011年1-12月高血压及高血压伴发1³种疾病的782份病历作为对照组;2012年9月-2013年8月高血压及高血压伴发13种疾病的782份病历作为对照组;2012年9月-2013年8月高血压及高血压伴发1³种疾病的1 061份病历作为观察组。把2组病例均划分为8个疾病组,临床药师对观察组进行干预后,比较对照组与观察组病例的药物使用合理率数据。结果:高血压、高血压伴发冠心病、高血压伴发心力衰竭、高血压伴发糖尿病、高血压伴发冠心病及心力衰竭组差异有统计学意义(P<0.01);高血压伴发冠心病及糖尿病组差异有统计学意义(P<0.05);高血压伴发心力衰竭及糖尿病组,高血压伴发冠心病、心力衰竭及糖尿病组,因样本量太小,差异无统计学意义(P>0.05)。8组疾病组病例数汇总后比较药物使用不合理率,观察组与对照组差异有统计学意义(P<0.01)。结论:临床药师在药学查房期间,通过对护士和患者的宣教以及药物在临床不合理使用的干预,可显著提高药物使用合理性,保证患者用药的安全、有效,达到医患共赢的效果。     

医保准入后德谷门冬双胰岛素对比甘精胰岛素治疗口服降糖药控制不佳的中国2型糖尿病患者的成本-效果

目的:评价在德谷门冬双胰岛素医保谈判准入后,口服降糖药控制不佳的中国2型糖尿病患者应用德谷门冬双胰岛素治疗的长期成本-效果.方法:基于IQVIA?CORE糖尿病模型,计算德谷门冬双胰岛素和甘精胰岛素治疗30年的成本和健康产出,并进行增量成本-效果分析.研究采用卫生系统视角,成本包括降糖治疗、疾病管理及并发症治疗成本,健...     

应用磺脲类药物和二甲双胍治疗2型糖尿病失效后补充第3种降糖药的选择

目的:对应用磺脲类药物和二甲双胍后血糖仍控制不佳的2型糖尿病患者,观察补充第3种药物控制血糖的效果和安全性。方法:119例2型糖尿病患者(年龄(56.1±14.0)岁,糖化血红蛋白A(1HbA1c)(9.1±1.6)%)分为3组,分别随机补充甘精胰岛素、罗格列酮、阿卡波糖,根据血糖调整3种药物用量。补充药物治疗24周前、后,分别测定3组患者的HbA1c、空腹血糖(FPG)、体质量等指标变化。结果:甘精胰岛素组血糖(HbA1c(-1.66±0.24)%,FPG(-3.68±0.28)mmol·L-1)改善比罗格列酮组(HbA1c(-1.15±0.17)%,FPG(-2.85±0.26)mmol·L-1)、阿卡波糖组(HbA1c(-0.75±0.22)%,FPG(-1.85±0.26)mmol·L-1)更明显(P<0.05)。与口服降糖药(罗格列酮或者阿卡波糖)比较,甘精胰岛素组患者外周水肿、胃肠道反应等发生几率更少或更轻微(P<0.05),仅体质量增加比阿卡波糖组明显(P<0.05)。3组患者低血糖发生率和治疗费用差异无统计学意义(P>0.05)。结论:对应用磺脲类药物和二甲双胍后血糖仍控制不佳的2型糖尿病患者,补充甘精胰岛素比补充口服降糖药(罗格列酮或者阿卡波糖)降糖效力更强,且副作用无明显增加。     

Type 2 diabetes in pediatrics and adults: thoughts from a clinical pharmacology perspective

Type 2 diabetes results when insulin secretion is unable to keep the plasma glucose levels as per acceptable range. This leads to chronic hyperglycemia and its associated microvascular complications such as renal impairment (diabetic nephropathy), retinal abnormalities (diabetic retinopathy), and autonomic, sensory, and motor neuropathies (diabetic neuropathy) and macrovascular disease. Historically, type 2 diabetes is well known as an adult-onset disease; however, lately, the incidence of the disease is reported to be increasing in children. Despite the wealth of information concerning type 2 diabetes in adults, data unique to the pediatric age group regarding the pathophysiology and therapy for type 2 diabetes are limited. For treatment in pediatric type 2 diabetes, metformin and insulin are the only antidiabetic agents approved currently. There are data of use of other oral antidiabetic drugs including glimepiride, rosiglitazone, and glyburide (in combination with metformin) in pediatric patients; however, formal clinical trials to establish the safety and efficacy have not been conducted. This review will compare the clinical pharmacology aspects of the oral type 2 diabetic drugs in pediatric and adult populations in order to determine any differences between the two patient groups.     

Health care costs associated with escalation of drug treatment in type 2 diabetes mellitus.

The cost of different intensities of therapy in HMO patients with type 2 diabetes mellitus was studied. Health care utilization data from 1995 were obtained for 12,200 registrants from the Kaiser Permanente Northwest Diabetes Registry who had type 2 diabetes mellitus. The data were used to determine costs associated with the escalation of antidiabetic therapies in persons with type 2 diabetes mellitus. The total annual costs (in 1993 dollars) associated with no drug therapy, a sulfonylurea only, metformin, a sulfonylurea plus insulin, and insulin alone were $4400, $4187, $4838, $8856, and $7365, respectively. Per patient total costs were higher for patients who had received antidiabetic therapy in 1995 or previously than for those who had not ($5303 versus $4365) and for patients who had received insulin therapy than for those who had not ($7379 versus $4117). Macrovascular complications accounted for 62-89% of the cost associated with inpatient treatment of diabetes-related complications. The total cost of treating patients with type 2 diabetes mellitus at an HMO increased as antidiabetic therapies escalated.     

Interindividual variability in oral antidiabetic drug disposition and response: the role of drug transporter polymorphisms

BACKGROUND: Numerous effective oral pharmacologic therapies are available to treat type 2 diabetes. However, a substantial number of patients do not achieve the expected glucose-lowering response, or may be predisposed to adverse effects, from these agents. The application of pharmacogenetics to the field of type 2 diabetes is one step towards the goal of improved pharmacotherapeutic management of this progressive disease. METHODS: A PubMed literature search was conducted to identify clinical studies that have examined the extent to which drug-transporter gene polymorphisms influence interindividual variability in oral antidiabetic drug disposition and response in humans. RESULTS/CONCLUSION: Available data suggest that drug transporters play an important role in the disposition of some oral antidiabetic drugs in the body, particularly the meglitinides and metformin. Moreover, polymorphisms in genes encoding drug transport proteins may alter the pharmacodynamic profile of these agents. Drug transporters, drug-metabolizing enzymes, and drug targets each play a distinct and important role in the disposition and action of many oral antidiabetic agents. Thus, future studies may need to take a pharmacogenomic (i.e., multiple gene) approach in order to comprehensively understand the extent to which genetic variation contributes to interindividual differences in oral antidiabetic drug clinical pharmacology.     

3种口服降糖方案治疗2型糖尿病的最小成本分析

目的：观察3种常用的口服降糖方案治疗2型糖尿病的疗效并比较用药费用,进行最小成本分析,从而为临床合理用药提供参考。方法：将符合2型糖尿病诊断的患者126例分为A、B、C 3组,分别为格列吡嗪＋二甲双胍（A组）、格列吡嗪＋阿卡波糖（B组）、格列美脲＋二甲双胍（C组）,比较3组的疗效,并进行最小成本分析。结果：A、B、C 3组的有效率分别为88.6%、90.5%和87.5%,3组有效率比较无统计学意义（P〉0.05）;A、B、C 3组的降糖药总费用分别为（266.3±31.6）元、（648.4±34.3）元和（356.8±41.2）元,A组的药品费用最低。结论：3种口服降糖方案均是有效的2型糖尿病治疗方案,但A组方案治疗成本最低,是治疗2型糖尿病的一个较好选择。     

Troglitazone: a review of its use in the management of type 2 diabetes mellitus

Troglitazone is the first of a new group of oral antidiabetic drugs, the thiazolidinediones, and is indicated for the treatment of patients with type 2 (non-insulin-dependent) diabetes mellitus. Troglitazone acts by enhancing the effects of insulin at peripheral target sites and, unlike the sulphonylurea drugs, is not associated with hypoglycaemia when administered as monotherapy. Clinical trials with troglitazone (usually 200 to 600 mg/day) in patients with type 2 diabetes mellitus consistently showed marked improvement in glycaemic control, as well as reductions in fasting serum insulin, C-peptide and triglyceride levels. Comparative studies with either glibenclamide (glyburide) or metformin indicated similar glycaemic control with troglitazone or these agents. Serum insulin levels were lower with troglitazone than with glibenclamide. Clinical trials of up to approximately 2 years' duration showed that glycaemic control is maintained with troglitazone on a long term basis. In general, troglitazone is well tolerated by the majority of patients. However, discontinuation of troglitazone because of elevated liver enzyme levels occurs in approximately 2% of patients receiving the drug, and frequent monitoring of liver enzymes is required (e.g. at least 11 times during the first year of therapy). Among patients who started troglitazone therapy in 1998 (after the incorporation of a boxed warning and increased monitoring requirements in the product labelling), the estimated risk of liver-related death is approximately 1 in 100,000. CONCLUSIONS: Troglitazone improves the ability of target cells to respond to insulin. The drug has been shown to improve glycaemic control in patients with type 2 diabetes mellitus when used as monotherapy or in combination with other oral antidiabetic drugs or insulin, and its efficacy is similar to that of glibenclamide or metformin. Although troglitazone is generally well tolerated, close monitoring of liver enzyme function is required to minimise the rare occurrence of serious hepatic dysfunction. Drug acquisition and liver function monitoring costs, as well as potential adverse effects, are important factors that may ultimately determine the precise place of troglitazone in the management of type 2 diabetes mellitus. Nevertheless, as the first member of a new class of oral antidiabetic agents, the thiazolidinediones, troglitazone offers an effective treatment option in patients with type 2 diabetes mellitus through its action of improving insulin sensitivity.