二甲双胍对2型糖尿病患者血脂的影响

本研究观察了二甲双胍对2型糖尿病（DM）患者高脂蛋白血症载脂蛋白Al（ApoAl）、载脂蛋白B（ApoB）、高密度脂蛋白（HDL）的影响，并以格列毗嗪为对照，观察其改变是否与血糖下降有关。     

二甲双胍对2型糖尿病大鼠肠神经GLP-1受体表达的影响

目的研究二甲双胍对2型糖尿病（Type2diabetesmellitus,T2DM）大鼠肠神经细胞胰高血糖样肽-1受体（Glucagon—likepeptide-1 receptor,GLP-1R）表达的影响,探讨二甲双胍用药后肠神经GLP-1R的表达变化与血糖的关系。方法雄性Wistar大鼠随机分为3组,每组6只：wistar正常大鼠组（W-C）;T2DM模型对照组（T2DM—C）;T2DM二甲双胍组（T2DM—M）。分别测定各组大鼠用药前及用药后第2、8周空腹血糖、空腹血清GLP-1,用药前及用药后8周空腹血清胰岛素。第8周处死各组大鼠,RT-PCR和免疫印迹法（Westernblot）测定回肠末端肌间神经丛GLP一1RmRNA和蛋白的水平。结果T2DM—M组大鼠用药后空腹血糖及空腹血清胰岛素较前显著降低（P〈0．01）,空腹血清GLP一1较前显著升高（P〈0．01）,与同时间点T2DM—C组相比差异有统计学意义（P〈0．01）。用药后第8周,RT—PCR结果显示GLP-1RmRNA在T2DM—M组肠神经丛表达水平明显高于T2DM—C组GLP-1RmRNA的表达水平（P〈0．01）。Western—blot结果显示T2DM-M组肠神经丛GLP-1R蛋白表达水平明显高于T2DM—C组肠神经丛GLP-1R蛋白表达水平（P％0．05）。结论二甲双胍能显著提高T2DM大鼠肠神经GLP-1R的表达,可能在二甲双胍降低2型糖尿病的血糖中发挥了重要作用。     

二甲双胍对2型糖尿病患者血脂代谢的临床研究

目的：探讨二甲双胍对伴高脂血症的2型糖尿病患者血脂的影响。方法：将60例伴高脂血症的2型糖尿病患者随机分为两组,试验组（n=30）服用二甲双胍加优降糖,对照组（n=30)单用优降糖,治疗半年。结果：在血糖控制满意的情况下,试验组治疗后TC、TG、LDL－C较治疗前明显下降（P＜0．001）,HDL－C较治疗前明显升高（P＜0．05）,而对照组治疗前后TC、TG、LDL－C、HDL－C变化不明显（P＞0．05）。结论：二甲双胍可改善2型糖尿病患者的血脂代谢。     

西格列汀联合二甲双胍治疗2型糖尿病1例

患者资料患者,男,43岁,出租车司机.以"口干多饮、多尿、体重减轻(约5kg)3年"入院.在我院经监测血糖及OGTT确诊为2型糖尿病,给予饮食运动控制,二甲双胍850mg bid治疗,血糖仍高,加用格列齐特缓释片90mg qd治疗后症状好转,但血糖控制未达标.近来双眼轻度视物模糊,偶有肢端刺痛,无便秘腹泻交替、间歇性跛行、尿不尽感、足肿、头昏、胸闷等症状,监测随机血糖在10～ 13mmol/L,HbA1c9.5％.该患者无糖尿病家族史,既往有慢性胃炎病史.     

二甲双胍对高血压合并2型糖尿病患者血压血脂的影响

目的对二甲双胍对高血压合并2型糖尿病降压和调脂疗效进行探讨与分析。方法选取72例患者,随机分成两组,二甲双胍观察组47例,对照组25例,观察组使用二甲双胍750~1500 mg/d,缬沙坦80~160 mg/d,患者每日早晚共测量2次,对收缩压(SBP)与舒张压(DBP)进行记录。结果观察组47例,疗效显著,治疗后自身比较差异有统计学意义,P<0.05,收缩压和舒张压较治疗前均有明显下降,血压降至正常范围,对照组总有效率明显低于观察组,血压未降至正常范围,二甲双胍观察组在治疗12周后复查结果 TC、LDL、TG明显下降,治疗后差异有统计学意义,P<0.05。结论二甲双胍对高血压合并2型糖尿病(DM)的患者有良好的调脂降压疗效。     

瑞格列奈片、二甲双胍联合步行锻炼对社区2型糖尿病患者血脂代谢的影响

目的 探讨瑞格列奈片、二甲双胍联合步行锻炼对社区2型糖尿病患者血脂代谢的影响.方法 以社区内82例2型糖尿病患者为研究对象,随机分为对照组(41例)和观察组(41例).对照组采用二甲双胍治疗;观察组同时给予瑞格列奈片.治疗期间,两组患者均遵医嘱进行步行锻炼.检测两组治疗前后空腹、餐后2h及睡前血糖水平.比较治疗前后两组血脂代谢水平变化,观察不良反应发生情况.结果 治疗后,观察组TG、TC、LDL-C、HDL-C水平分别为[(1.27±0.54)、(4.17±0.43)、(2.31±0.58)、(1.84±0.57)]mmol/L,与本组治疗前与对照组治疗后比较差异均有统计学意义(P＜0.05);观察组空腹、餐后2h及睡前血糖水平[(5.73±1.45)、(7.36±1.62)、(7.18±1.66) mmol/L]低于对照组,差异有统计学意义(P＜0.05).结论 瑞格列奈片、二甲双胍联合步行锻炼能有效控制患者血糖水平,改善患者血脂代谢,安全可靠.     

胰岛素联合二甲双胍对2型糖尿病糖化血红蛋白的影响

目的:观察探讨2型糖尿病患者接受胰岛素与二甲双胍联合治疗后糖化血红蛋白(HbA1c)的水平变化.方法:选取120例2型糖尿病病例,随机分为3组,分别给予单独胰岛素(胰岛素组)、单独二甲双胍(二甲双胍组)和胰岛素联合二甲双胍治疗(联合组).对比临床效果、治疗前后空腹血糖(FBP)和HbA1c水平.结果:联合组总有效率远高于胰岛素组和二甲双胍组(P<0.05),胰岛素组与二甲双胍组总有效率比较无显著差异(P>0.05);治疗前三组FBP、HbA1c水平比较均无显著差异(P>0.05),治疗后均较本组内治疗前显著降低(P<0.05),且治疗后胰岛素组与二甲双胍组上述指标水平远低于联合组(P<0.05),治疗后胰岛素组与二甲双胍组上述指标数据均无显著差异(P>0.05).结论:胰岛素和二甲双胍均能改善2型糖尿病患者FBP和HbA1c水平,但是联合应用效果更佳,推荐使用.     

罗格列酮和二甲双胍对2型糖尿病患者血脂代谢的影响

目的 观察罗格列酮、罗格列酮二甲双胍复方制剂和二甲双胍对新发2型糖尿病患者血脂代谢的影响.方法 120例新发2型糖尿病患者完全随机分为A组、B组、C组和D组各30例,A组单纯予以糖尿病饮食控制同时配合运动锻炼治疗;B组予以二甲双胍(餐前即服)0.5/次,2次/d治疗;C组予以罗格列酮(餐前服用)2 mg/次,2次/d治疗,D组予以复方二甲双胍罗格列酮复方制剂1片/次,2次/d.经过12周治疗后观察血脂变化.结果 完成试验者共116例,4组患者TC、TG较治疗前均有明显下降(P＜0.05),且C组与B组比较,TG下降差异有统计学意义[(1.5±0.9)mmol/L比(1.7±1.0)mmol/L,P＜0.05];C组和B组HDL-C明显上升(P＜0.05),组间比较两者差异有统计学意义[(1.3±0.5)mmol/L比(1.3±0.6)mmol/L,P＜0.01);C组的LDL-C下降较治疗前差异具有统计学意义[(4.3±1.1)mmol/L比(1.1±0.4)mmol/L,P＜0.05);D组与C组比较TG下降、HDL-C上升、LDL-C下降,差异有统计学意义(P＜0.05).结论 罗格列酮二甲双胍复方制剂、罗格列酮和二甲双胍均有改善2型糖尿病患者血脂代谢的作用,但罗格列酮二甲双胍复方制剂的作用要强于罗格列酮、罗格列酮强于二甲双胍.     

二甲双胍、格列美脲联合甘精胰岛素治疗2型糖尿病

目的探讨二甲双胍、格列美脲联合甘精胰岛素治疗2型糖尿病的临床疗效。方法 120例2型糖尿病患者,随机分为对照组和治疗组各60例,对照组采用西医常规疗法口服降糖药(二甲双胍和格列美脲),治疗组在对照组的基础上加用长秀霖注射治疗,治疗2周后观察并记录两组的血糖达标时间、糖代谢情况、血脂情况、发生低血糖次数。结果 120例患者经过2周治疗后,患者的FPG、2hPG、HbAl c均明显的下降,FCP、2hCP有所升高,与治疗前相比差异具有统计学意义(P<0.05);治疗组的2hPG、FPG、HbAl c下降水平大于对照组,治疗组的FCP和2hCP增加水平大于对照组;患者的TG、TC、LDL-C均明显的下降,HDL-C有所升高,与治疗前相比差异具有统计学意义(P<0.05);治疗组的TG、TC、LDL-C下降水平大于对照组,治疗组的HDL-C升高水平大于对照组;治疗组的达标时间短于对照组,两组差异具有统计学意义(P<0.05);治疗组的低血糖发生率小于对照组,两组差异具有统计学意义(P<0.05)。结论二甲双胍、格列美脲联合甘精胰岛素治疗2型糖尿病临床降糖效果好、长效平稳且安全性高,值得临床推广。     

瑞格列奈联合二甲双胍和二甲双胍比较治疗2型糖尿病的meta分析

目的:探讨比较瑞格列奈联合二甲双胍与二甲双胍治疗2型糖尿病(T2DM)的疗效和安全性。方法:检索Pub Med、EMbase、Medline、Cochrane、万方、CNKI、维普等文献数据库。按照Cochrane Handbook 5.1.0评价系统评价方法查找瑞格列奈联合二甲双胍与二甲双胍治疗2型糖尿病的随机对照试验(RCT),进行数据提取和质量评价后,采用Rev Man 5.2软件进行meta分析。结果:共纳入13个RCT的文献,847名患者。meta分析结果显示:在降低患者糖化血红蛋白[WMD=-1.08,95%CI(-1.27,-0.90),P<0.000 01]、空腹血糖[WMD=-1.79,95%CI(-2.04,-1.54),P<0.000 01]和餐后2 h血糖[WMD=-2.13,95%CI(-2.60,-1.66),P<0.000 01]方面,瑞格列奈联合二甲双胍组优于二甲双胍组。在低血糖反应发生率[WMD=3.00,95%CI(1.36,6.64),P=0.007]方面,联合用药组高于二甲双胍组,但两组在胃肠道反应发生率[WMD=0.70,95%CI(0.37,1.31),P=0.26]方面的差异没有统计学意义。结论:瑞格列奈联合二甲双胍治疗2型糖尿病的疗效优于二甲双胍单独治疗的疗效。上述结论尚待开展更多大样本、高质量研究予以证实。     

胰高血糖素样肽-1受体激动剂调节2型糖尿病糖脂代谢研究进展

胰高血糖素样肽-1（glucagon-like peptide-1,GLP-1）受体激动剂类药物是一类新型抗糖尿病药物,可呈血糖依赖性地促进胰岛素的分泌、减慢胃排空、增加外周组织对葡萄糖的摄取,从而起到控制血糖的作用。本文对GLP-1受体激动剂近年来的国内外文献进行综述,从其对血糖、血脂及体质量等方面的影响展开分析,并比较了不同GLP-1受体激动剂之间,及与其他降糖药物之间的疗效差异,旨在阐明此类药物在改善2型糖尿病代谢方面的作用特点。     

The novel use of GLP-1 analogue and insulin combination in type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is a global public health problem. Due to the progressive nature of the disease, a combination(s) of two or more drugs acting on different pathophysiological process is often necessary to achieve early and sustained achievement of individualized glycemic targets. At the same time, choosing the safest option to avoid hypoglycemia is of paramount importance. GLP-1 analogues are a relatively recent class of anti-diabetic drugs, and are highly effective with an acceptable safety profile. Attempts have been made to combine GLP-1 analogues with basal insulin for management of T2DM. Presently GLP-1 analogues like exenatide/long acting exenatide and liraglutide have been co-administered with basal insulin like glargine and detemir respectively, and are approved by regulatory agencies. Currently a fixed dose combination (FDC) of insulin degludec and liraglutide is under development. GLP-1 analogue and insulin as FDC or by co-administration, is a rational method of controlling fasting and postprandial glucose effectively. The efficacy and safety of this combination has been studied in a wide population with promising outcomes. Innovative use of GLP-1 analogues beyond diabetes is also being attempted, and a variety of patents are filed or granted for the same. This review summarizes the current status of GLP-1 and insulin combination in the management of T2DM and highlights the new frontiers in research involving GLP-1. Patents on combination of GLP-1 and insulin which were granted earlier, and the ones which have been applied for, are also discussed.     

Insulin and GLP-1 analog combinations in type 2 diabetes mellitus: a critical review

Introduction: Glucagon-like peptide-1 (GLP-1) receptor agonists have been used in clinical management of type 2 diabetes since 2005. Currently approved agents were initially developed and approved for combination therapy with oral antidiabetic drugs (OADs). The potential for combined use with insulin has garnered increasing attention due to the potential to reduce side effects associated with insulin therapy and improve glycemic control. Areas covered: We reviewed published and other publicly released data from controlled and uncontrolled studies that included subjects treated with insulin/GLP-1 analog combination therapy. The currently available guidance for clinical practice when combining insulin and GLP-1 analogs was also summarized. Expert opinion: Limited data currently available from placebo-controlled trials support the use of exenatide twice daily or liraglutide once daily in combination with basal insulin and metformin in subjects with type 2 diabetes unable to attain treatment goals. Several randomized controlled trials are currently studying combinations of insulin with various GLP-1 analogs. Additional guidance on the clinical use of these combinations will likely be forthcoming once these studies are reported. Insulin/GLP-1 analog combinations will require optimization of blood glucose monitoring strategies and delivery systems to decrease the risk of administration errors and reduce the potential complexity of these regimens.     

The management of obesity in type 2 diabetes mellitus

Prevalence of obesity in the United Kingdom has tripled in the last 20 years and this is driving an epidemic of type 2 diabetes. Indeed, today the vast majority of patients with type 2 diabetes are overweight or obese. Effective weight management leading to modest weight loss to the order of 5-10% of body weight can lead to significant clinically meaningful benefits provided it can be maintained. Thus weight management can lead to improved glycaemic control, better blood pressure control and lipid control in addition to other benefits. Management of diabetic patients who are obese requires management also of other associated co-morbid conditions and it is important to ensure that glycaemic control does not deteriorate during weight management. An integrated approach to weight management in the diabetic patient is recommended which helps to promote lifestyle modification for all patients. Drug therapy may be appropriate for many obese patients who do not reach target weight loss with lifestyle modification alone. Surgery should be reserved for those wfth BMI >40 only after failed medical therapy.     

Insulin and GLP-1 analog combinations in type 2 diabetes mellitus: a critical review

Introduction: Glucagon-like peptide-1 (GLP-1) receptor agonists have been used in clinical management of type 2 diabetes since 2005. Currently approved agents were initially developed and approved for combination therapy with oral antidiabetic drugs (OADs). The potential for combined use with insulin has garnered increasing attention due to the potential to reduce side effects associated with insulin therapy and improve glycemic control.

Areas covered: We reviewed published and other publicly released data from controlled and uncontrolled studies that included subjects treated with insulin/GLP-1 analog combination therapy. The currently available guidance for clinical practice when combining insulin and GLP-1 analogs was also summarized.

Expert opinion: Limited data currently available from placebo-controlled trials support the use of exenatide twice daily or liraglutide once daily in combination with basal insulin and metformin in subjects with type 2 diabetes unable to attain treatment goals. Several randomized controlled trials are currently studying combinations of insulin with various GLP-1 analogs. Additional guidance on the clinical use of these combinations will likely be forthcoming once these studies are reported. Insulin/GLP-1 analog combinations will require optimization of blood glucose monitoring strategies and delivery systems to decrease the risk of administration errors and reduce the potential complexity of these regimens.     

对二甲双胍的再认识

二甲双胍作为最早的口服降糖药物之一,在糖尿病的治疗舞台上经历了50余年的风风雨雨,可以形容为“历久弥新五十年,经典用药谱新篇”。伴随着近年来国际、国内糖尿病预防和治疗观念的不断发展,以及对二甲双胍这一经典药物的临床使用的进一步认识,二甲双胍在2型糖尿病治疗领域的地位得到进一步提升，存预防糖耐量损害（IGT）转变为糖尿病的大型研究中显示了它的良好效果。     

瑞格列奈联合盐酸二甲双胍对2型糖尿病疗效的影响

目的 探讨瑞格列奈联合盐酸二甲双胍对2型糖尿病疗效的影响.方法 选择已确诊的初诊2型糖尿病患者120例,随机分观察组和对照组各60例.观察组给予瑞格列奈联合盐酸二甲双胍治疗,对照组给予盐酸二甲双胍治疗.观察两组治疗前后、1、2、4周时各项指标变化情况.结果 治疗前后两组的空腹血糖、餐后2 h血糖水平明显降低,差异有统计学意义(P<0.05);治疗后观察组的空腹血糖、餐后2 h血糖水平各项指标明显优于对照组,两组比较差异有统计学意义(P<0.05).结论 瑞格列奈联合盐酸二甲双胍治疗初诊2型糖尿病效果满意,优于单纯用药.     

Liraglutide: a once-daily GLP-1 analogue for the treatment of type 2 diabetes mellitus

The incretin hormones are intestinal peptides that enhance insulin secretion following ingestion of nutrients. Liraglutide is a glucagon-like peptide-1 receptor analogue, which is obtained by derivatising glucagon-like peptide-1 with a fatty acid, providing a compound with pharmacokinetic properties that are suitable for once-daily dosing. Liraglutide has demonstrated lasting improvement of HbA(1c )levels, weight reduction and improved beta-cell function in patients with Type 2 diabetes mellitus. Liraglutide is well tolerated; the adverse events that are most frequently reported being transient nausea and diarrhoea. This article reviews the mechanisms of action and efficacy of liraglutide for the treatment of Type 2 diabetes mellitus. This agent is presently in Phase III clinical development.     

艾塞那肽联合二甲双胍对2型糖尿病伴肥胖患者的干预效果

目的 探讨艾塞那肽联合二甲双胍对2型糖尿病(T2DM)伴肥胖患者的干预效果.方法 选取本院2012年1月至2015年1月期间收治的T2DM伴肥胖患者78例,以随机数表法分为观察组和对照组,每组各39例.观察组给予艾塞那肽联合盐酸二甲双胍治疗,对照组给予盐酸二甲双胍口服治疗,两组治疗周期均为12周;比较治疗前后两组患者体重(BW)、腰围(W)、体重指数(BMI)、血脂总胆固醇(TC)、甘油三酯(TG)、血糖(FBG)、餐后2h血糖(2 hPBG)控制及胰岛素分泌指数(HOMA-％B)、胰岛素抵抗指数(HOMA-R)的变化,并观察和比较两组不良反应和低血糖发生情况.结果 治疗前后,观察组BW、W、BMI、TC、TG、FBG、2hPBG、HOMA-％B、HOMA-R比较差异有统计学意义(P＜0.05),对照组仅BW、TC、2hPBG、HOMA-R比较差异有统计学意义(P＜0.05);治疗后与对照组比较,观察组W(96.56±7.22) cm、BMI(25.03±2.33)kg/m、TG(3.09±0.21) mmol/L、FBG(7.09±1.07)mmol/L、2hPBG(10.04±2.12)mmol/L、HOMA-R(3.10±0.77)显著低于对照组(P＜0.05);HOMA-％B显著高于对照组(P＜0.05);观察组不良反应为10.26％显著低于对照组的33.33％(P＜0.05).结论 艾塞那肽联合二甲双胍能有效减低T2DM伴肥胖患者的血糖水平和体重指数,并有效改善血脂代谢,减轻胰岛素抵抗,是一种值得临床推广的安全方案.