奥利司他联合西格列汀二甲双胍对肥胖型2型糖尿病患者稳态模型胰岛素抵抗指数和胰岛β细胞功能指数的影响

目的分析奥利司他联合西格列汀二甲双胍对肥胖型2型糖尿病患者稳态模型胰岛素抵抗指数(HOMA-IR)、稳态模型胰岛β细胞功能指数(HOMA-β)的影响。方法将86例肥胖型2型糖尿病患者按随机数字表法分组,每组43例。对照组以西格列汀二甲双胍治疗,观察组在对照组基础上加奥利司他口服,比较两组治疗效果、血糖指标等。结果对照组、观察组治疗总有效率分别为76.74%、93.02%,组间比较差异有统计学意义(P0.05);治疗后与对照组比,观察组空腹血糖、餐后2 h血糖水平显著下降,同时总胆固醇、三酰甘油水平明显降低(P0.05),高密度脂蛋白明显升高(P0.05)。治疗后,观察组稳态模型胰岛素抵抗指数明显低于对照组,稳态模型胰岛β细胞功能指数明显高于对照组(P0.05)。两组不良反应发生率差异无统计学意义(P0.05)。结论奥利司他联合西格列汀二甲双胍对肥胖型2型糖尿病患者疗效显著,能有效改善血糖、血脂指标,且可改善胰岛β细胞功能,减轻机体的胰岛素抵抗情况。     

Clinical efficacy of orlistat therapy in overweight and obese patients with insulin-treated type 2 diabetes: A 1-year randomized controlled trial

OBJECTIVE; Weight loss improves glycemic control, lipid profiles, and blood pressure in patients with type 2 diabetes. However, successful long-term weight loss is difficult for these patients, particularly those treated with insulin. The aim of this study was to assess the effect of orlistat, a gastrointestinal lipase inhibitor, on weight loss, glycemic control, and cardiovascular risk factors in overweight or obese insulin-treated type 2 diabetic patients. RESEARCH DESIGN AND METHODS: This study was a 1-year multicenter, randomized, double-blind, placebo-controlled trial of orlistat (120 mg three times a day) or placebo combined with a reduced-calorie diet in overweight or obese adults (BMI 28-40 kg/m(2)) with type 2 diabetes treated with insulin alone or combined with oral agents, but with suboptimal metabolic control (HbA(1c) 7.5-12.0%). Outcome measurements included changes in body weight, glycemic control, blood pressure, and serum lipids. RESULTS; After 1 year, the orlistat group lost significantly more weight (-3.89 +/- 0.3% of baseline body weight, means +/- SE) than the placebo group (-1.27 +/- 0.3%, P < 0.001). Orlistat treatment, compared with placebo, produced greater decreases in HbA(1c) (-0.62 +/- 0.08 vs. -0.27 +/- 0.08%, P = 0.002), fasting serum glucose (-1.63 +/- 0.3 vs. -1.08 +/- 0.3 mmol/l, P = 0.02), and the required doses of insulin and other diabetic medications. Orlistat also produced greater improvements than placebo in serum total cholesterol (P = 0.0002) and LDL cholesterol concentrations (P = 0.001) and LDL/HDL ratio (P = 0.01). CONCLUSIONS; Orlistat therapy produces clinically significant weight loss, with improvements in glycemic control and cardiovascular disease risk factors, in overweight or obese patients with type 2 diabetes who have suboptimal metabolic control with insulin therapy.     

Acarbose improves glycemic control in overweight type 2 diabetic patients insufficiently treated with metformin

OBJECTIVE: To investigate the efficacy and safety of acarbose as add-on therapy in overweight type 2 patients with diabetes inadequately controlled by metformin. RESEARCH DESIGN AND METHODS: This study adopted a multicenter, randomized, double-blind, placebo-controlled, parallel group design. After a 4-week placebo run-in period, subjects were randomized to either acarbose (titrated up to 100 mg b.i.d.) or placebo. The primary efficacy variable was the change in HbA(1c) from baseline to the end of the 24-week treatment period. Change in fasting blood glucose was assessed as a secondary efficacy parameter. RESULTS: The intention-to-treat analysis from baseline to week 24 (81 patients for HbA(1c) and 82 for fasting blood glucose) showed statistically significant differences between acarbose and placebo treatment in HbA(1c) (1.02%; 95% CI 0.543-1.497; P = 0.0001) and fasting blood glucose (1.132 mmol/l; 95% CI 0.056-2.208; P = 0.0395) (adjusted least square means). In all, 18 patients (47%) in the acarbose group were classified as responders with a > or =5% reduction in HbA(1c) (relative to baseline) at the end point compared to 6 (14%) in the placebo group (P = 0.001). The safety profiles were similar for both treatment groups except for the higher incidence of gastrointestinal side effects during acarbose therapy. CONCLUSIONS: The addition of acarbose to metformin monotherapy provides an efficacious and safe alternative for glycemic improvement in overweight type 2 patients inadequately controlled by metformin alone.     

西格列汀联合二甲双胍治疗肥胖2型糖尿病患者的疗效分析

目的：探讨西格列汀联合二甲双胍治疗肥胖2型糖尿病患者并控制血糖的临床疗效。方法筛选86例肥胖2型兼血糖控制不佳的新诊断的糖尿病患者。随机分为两组,两组患者均进行糖尿病饮食控制和适量运动。在此基础上,对照组患者采用阿卡波糖联合二甲双胍治疗;治疗组患者采用西格列汀联合二甲双胍治疗,治疗时间均为12周,分别于治疗前后检测两组患者糖基化血红蛋白（HbA1c）、空腹血糖（ FPG）、餐后2 h血糖（2 h FPG）、甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、体重指数（BMI）以及胰岛β细胞功能指数（HOMA-β）等指标。结果治疗组治疗后FPG、2 h FPG 、HbA1c、BMI与对照组治疗后比较,差异均有统计学意义（t分别=13.73、6.57、13.17、59.53,P均＜0.05）,而HOMA-β比较差异无统计学意义（t=1.10,P＞0.05）;且治疗组治疗后TC、TG、LDL-C、HDL-C与对照组治疗后比较,差异均有统计学意义（t分别=12.26、7.75、4.73、4.03,P均＜0.05）。结论西格列汀联合二甲双胍能有效降低血糖血脂,并控制患者体重,是针对2型糖尿病肥胖患者的有效治疗方案。     

阿格列汀对经二甲双胍治疗的肥胖2型糖尿病患者外周血氧化相关物质活性的影响

目的探讨阿格列汀对经二甲双胍治疗的肥胖2型糖尿病患者外周血清氧化相关物质活性的影响,并评估该方案的有效性与安全性。方法选取肥胖的2型糖尿病患者200例(均为二甲双胍单药控制不佳),随机分为观察组(100例)和对照组(100例)。对照组患者采用二甲双胍(1 000mg bid,po)治疗,观察组使用二甲双胍(500mg bid,po)联合阿格列汀(25mg qd,po)治疗。2组患者规范治疗24周,比较2组治疗前后外周血超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、活性氧类物质(ROS)活性以及丙二醛(MDA)浓度、体质量指数(BMI)、腰围、糖化血红蛋白(HbA1c)、空腹血糖(FBG)、餐后2h血糖(2hPBG)的变化情况。结果治疗后,2组患者ROS、MDA、FBG、2hPBG、HbA1c、BMI、腰围均较治疗前降低,差异有统计学意义(P0.05)。治疗后观察组患者各指标明显低于对照组,差异有统计学意义(P0.05);2组治疗后SOD、GSH-Px活性较治疗前升高,差异有统计学意义(P0.05),治疗后观察组患者各指标明显高于对照组,差异有统计学意义(P0.05)。结论阿格列汀联合二甲双胍可有效纠正肥胖2型糖尿病患者的外周血氧化与抗氧化物质的失衡,同时能降低患者BMI、腰围等指标,且不增加低血糖风险,具有临床价值。     

A randomized trial of sibutramine in the management of obese type 2 diabetic patients treated with metformin

OBJECTIVE: To evaluate the effects of sibutramine (15 and 20 mg/day) on weight, metabolic control, and blood pressure in metformin-treated obese subjects with type 2 diabetes. RESEARCH DESIGN AND METHODS: A 12-month randomized prospective placebo-controlled double-blind study was performed. It included 21 primary and secondary care centers in England, Canada, France, and Belgium. A total of 195 subjects (44% male) with type 2 diabetes and a BMI >27 kg/m(2) were studied. Changes were assessed in weight, blood pressure and resting heart rate, HbA(1c), fasting glucose, and lipids. RESULTS: Sibutramine induced significant weight loss (P < 0.001) with both 15 mg/day (5.5 +/- 0.6 kg at 12 months) and 20 mg/day (8.0 +/- 0.9 kg), whereas placebo did not (0.2 +/- 0.5 kg). Weight loss > or = 10% was achieved by 14 and 27% of subjects receiving 15 and 20 mg, respectively, but by none given placebo. Glycemic control improved in parallel with weight loss, and subjects who lost > or = 10% weight showed significant decreases in both HbA(1c) (1.2 +/- 0.4%, P < 0.0001) and fasting plasma glucose (1.8 mmol/l, P < 0.001). HDL cholesterol increased slightly with the higher dose, whereas plasma triglycerides fell with both doses, especially in subjects with weight loss of > or = 10% (a 29% decrease, P < 0.01). Treatment was generally well tolerated. Sibutramine treatment raised sitting diastolic blood pressure by > or = 5 mmHg in a higher proportion of patients than did placebo (43% with 15 mg/day vs. 25% with placebo, P < 0.05), but this effect was less evident in subjects who had a weight loss of > or = 10% weight. Pulse rate increased significantly more with sibutramine, being > or = 10 bpm higher in 42% of treated patients versus 17% with placebo (P < 0.01). CONCLUSIONS: Sibutramine can be an effective adjunct to metformin treatment in selected obese type 2 diabetic subjects and improves metabolic control in individuals who lose weight.     

Favorable effects of pioglitazone and metformin compared with gliclazide on lipoprotein subfractions in overweight patients with early type 2 diabetes

OBJECTIVE: To compare effects of different oral hypoglycemic drugs as first-line therapy on lipoprotein subfractions in type 2 diabetes. RESEARCH DESIGN AND METHODS: Sixty overweight type 2 diabetic patients not on lipid-lowering therapy were randomized to metformin, pioglitazone, or gliclazide after a 3-month dietary run-in. Drug doses were uptitrated for 3 months to optimize glycemia and were kept fixed for a further 3 months. LDL subfractions (LDL(1), LDL(2), and LDL(3)) were prepared by density gradient ultracentrifugation at randomization and study end. Triglycerides, cholesterol, total protein, and phospholipids were measured and mass of subfractions calculated. HDL subfractions were prepared by precipitation. The primary end point was change in proportion of LDL as LDL(3). RESULTS: HbA(1c), triglycerides, glucose, and cholesterol were comparable across groups at baseline and over time. LDL(3) mass and the LDL(3)-to-LDL ratio fell with pioglitazone (LDL(3) mass 36.2 to 28.0 mg/dl, P < 0.01; LDL(3)-to-LDL 19.2:13.3%, P < 0.01) and metformin (42.7 to 31.5 mg/dl, P < 0.01; 21.3:16.2%, P < 0.01, respectively) with no change on gliclazide. LDL(3) reductions were associated with reciprocal LDL(1) increases. Changes were independent of BMI, glycemic control, and triglycerides. Total HDL cholesterol increased on pioglitazone (1.28 to 1.36 mmol/l, P = 0.02) but not gliclazide (1.39 to 1.37 mmol/l, P = NS) or metformin (1.26 to 1.18 mmol/l, P = NS), largely due to an HDL(2) increase (0.3 to 0.4 mmol/l, P < 0.05). HDL(3) cholesterol fell on metformin (0.9 to 0.85 mmol/l, P < 0.01). On pioglitazone and metformin, the HDL(2)-to-HDL(3) ratio increased compared with no change on gliclazide. CONCLUSIONS: For the same improvement in glycemic control, pioglitazone and metformin produce favorable changes in HDL and LDL subfractions compared with gliclazide in overweight type 2 diabetic patients. Such changes may be associated with reduced atherosclerosis risk and may inform the choice of initial oral hypoglycemic agent.     

达格列净联合二甲双胍治疗肥胖2型糖尿病患者的效果及对脂肪细胞功能的影响

目的 观察达格列净联合二甲双胍治疗肥胖2型糖尿病患者的效果及对脂肪细胞功能的影响.方法 选取本院2019年1月至2020年7月收治的70例肥胖2型糖尿病患者作为研究对象,将其随机分为对照组和观察组,各35例.对照组采用二甲双胍治疗,观察组在对照组基础上给予达格列净治疗.比较两组治疗效果.结果 观察组治疗总有效率高于对照...     

Advantages of extended-release metformin in patients with type 2 diabetes mellitus

Metformin is a first-line pharmacological treatment for patients with type 2 diabetes mellitus because of its favorable overall profile, including its glucose-lowering ability, weight-neutral effects, and low risk of hypoglycemia; however, gastrointestinal (GI) intolerance may limit use in some patients. Extended-release metformin improves GI tolerability, allows once-daily dosing, and is currently available in multiple branded and generic formulations; however, it is more expensive than immediate-release metformin. Maximum plasma metformin concentrations are reached more slowly with the extended-release formulation compared with conventional immediate-release metformin, although both provide similar exposure at a given total daily dose. Extended-release metformin is as effective as immediate-release metformin in patients newly started on metformin and those switched from the immediate-release formulation, with similar weight-neutral effects. Tolerability is generally comparable, although patients switched from the immediate-release formulation--even those switched due to GI intolerance--are often better able to tolerate the extended-release formulation. Based on studies of extended-release formulations in other disease states, metformin extended-release formulation has the potential to improve patient adherence with a simpler dosing regimen and increased tolerability. Increased adherence may result in greater glycemic control, and in turn, improve outcomes and lower health care usage and costs. Extended-release metformin provides an appropriate option for patients with type 2 diabetes mellitus who require several medications to achieve glycemic control or manage comorbid conditions, and for those who have GI intolerance with the immediate-release formulation.     

Technological intervention for obese patients with type 2 diabetes

This study applied a 6-month educational intervention that used the technology of the short message service (via cellular phones) and the Internet for obese patients with type 2 diabetes. Eighteen patients were randomly assigned to an intervention group and 16 were assigned to a control group (N = 34). Patients in the intervention group were asked to access a web site by using personal cellular phones or computer Internet services to input their blood glucose levels daily. Participants were then sent optimal recommendations via cellular phone and the Internet weekly. After 6 months, the intervention group had a statistically significant decrease in glycosylated hemoglobin, fasting plasma glucose, 2-hour postmeal glucose, and total cholesterol, as compared with the control group.     

Efficacy of low-dose metformin in Japanese patients with type 2 diabetes mellitus

The goal of this study was to examine the antihyperglycemic effect of low-dose metformin in nonobese and obese Japanese patients with type 2 diabetes mellitus. After 3 months of reeducation and stabilization of diet therapy (25 kcal/kg of ideal body weight), metformin treatment was initiated. We administered metformin (500 to 750 mg daily) as monotherapy (n = 11) or in combination with a sulfonylurea (n = 14). After 6 months of treatment, the fasting plasma glucose level (mean ± SD) decreased from 190 ± 42 mg/dL to 155 ± 37 mg/dL and the glycated hemoglobin A_1c level (mean ± SD) from 8.8 ± 1.2% to 7.4 ± 1.0% in the monotherapy group. These same variables decreased from 218 ± 60 mg/dL to 162 ± 30 mg/dL and from 9.5 ± 1.2% to 8.4 ± 1.2% in the combination therapy group. All of these changes were statistically significant. Our results demonstrate that even low doses of metformin can improve hyperglycemia in Japanese patients with type 2 diabetes mellitus.     

津力达颗粒联合二甲双胍治疗初发2型糖尿病患者的疗效分析

目的观察津力达颗粒联合二甲双胍对初发2型糖尿病（T2DM）患者血糖控制的影响,并探讨其可能机制。方法将88例初发T2DM患者随机分为2组,每组44例。试验组予以津力达颗粒联合二甲双胍进行治疗,对照组予以二甲双胍进行治疗。随访16周,检测治疗前后2组患者空腹血糖（FPG）、餐后2小时血糖（2tLPG）、糖化血红蛋白（HbAlc）、空腹胰岛素（FINS）及脂肪因子水平,并计算治疗前后胰岛素抵抗指数（HOMA—IR）及体质量指数（BMI）。结果治疗后,2组HbAlc、FI）G、2hPG及BMI均较治疗前明显降低,差异有统计学意义;试验组与对照组HbAlc≤6．5％的患者分别为34例（82．9％）和24例（61．5％）,2组比较差异有统计学差异。治疗后,2组FINS、HOMA—IR及瘦素水平均较治疗前明显下降,而脂联素水平明显升高,且试验组各指标降低及升高幅度略大于对照组。2组不良反应均轻微,未见低血糖事件及明显肝肾功能损害。结论对于新诊断2型糖尿病患者,滓力达颗粒与二甲双胍联用可协同降低血糖,提高血糖达标率,2者对血浆瘦素、脂联素水平的调控是其纠正胰岛素抵抗的可能机制。     

二甲双胍对2型糖尿病合并亚临床甲状腺功能减退症患者血清促甲状腺激素水平的影响及性别差异分析

目的探讨二甲双胍对2型糖尿病(T2DM)合并亚临床甲状腺功能减退症(SCH)患者血清促甲状腺激素(TSH)水平的影响,并分析性别差异在其中的作用。方法将97例T2DM合并SCH患者按照是否服用二甲双胍分为组1(双胍组)和组2(非双胍组),另选35例应用二甲双胍但无甲状腺疾病的T2DM患者作为对照(组3)。比较3组患者用药前及治疗6个月后甲状腺功能及生化特征,采用相关分析和多元逐步回归分析影响TSH水平的因素。结果治疗6个月后,组1血清TSH水平较治疗前显著降低[(6.1±2.3)m IU/L vs.(3.2±1.4)m IU/L,P<0.05],女性TSH降低幅度大于男性,差异有统计学意义[(3.5±1.2)m IU/L vs.(2.1±1.7)m IU/L,P<0.05],而治疗前后FT3及FT4水平均无明显变化(P>0.05)。组2及组3治疗前后血清TSH、FT3及FT4水平均无明显变化。相关分析显示TSH变化值与性别、HOMA-IR呈显著负相关(r=-0.196、-0.220,均P<0.01),与腹高变化值呈显著正相关(r=0.627,P=0.000),多元逐步回归分析显示性别(P<0.01)和腹高变化值(P<0.01)是TSH水平变化值的独立影响因素。结论二甲双胍可降低T2DM合并SCH患者TSH水平,尤其是女性患者更为显著,这可能与减少内脏脂肪蓄积,改善腹型肥胖有关。     

Effect of metformin in pediatric patients with type 2 diabetes: a randomized controlled trial.

OBJECTIVE: Metformin is the most commonly prescribed oral antidiabetic agent in the U.S. for adults with type 2 diabetes. The incidence of type 2 diabetes in children has increased dramatically over the past 10 years, and yet, metformin has never been formally studied in children with type 2 diabetes. RESEARCH DESIGN AND METHODS: This study evaluated the safety and efficacy of metformin at doses up to 1,000 mg twice daily in 82 subjects aged 10-16 years for up to 16 weeks in a randomized double-blind placebo-controlled trial from September 1998 to November 1999. Subjects with type 2 diabetes were enrolled if they had a fasting plasma glucose (FPG) levels > or =7.0 and < or =13.3 mmol/l (> or =126 and < or =240 mg/dl), HbA(1c) > or =7.0%, stimulated C-peptide > or =0.5 nmol/l (> or =1.5 ng/ml), and a BMI > 50th percentile for age. RESULTS: Metformin significantly improved glycemic control. At the last double-blind visit, the adjusted mean change from baseline in FPG was -2.4 mmol/l (-42.9 mg/dl) for metformin compared with +1.2 mmol/l (+21.4 mg/dl) for placebo (P < 0.001). Mean HbA(1c) values, adjusted for baseline levels, were also significantly lower for metformin compared with placebo (7.5 vs. 8.6%, respectively; P < 0.001). Improvement in FPG was seen in both sexes and in all race subgroups. Metformin did not have a negative impact on body weight or lipid profile. Adverse events were similar to those reported in adults treated with metformin. CONCLUSION: Metformin was shown to be safe and effective for treatment of type 2 diabetes in pediatric patients.     

Combined metformin and insulin therapy for patients with type 2 diabetes mellitus

OBJECTIVE: This study was undertaken to assess the effects of combined treatment with insulin and metformin in patients with type 2 diabetes mellitus in whom dietary measures, weight control, and oral antihyperglycemic therapy had failed. BACKGROUND: Insulin resistance in peripheral tissues, increased hepatic gluconeogenesis, and impaired insulin secretion are the underlying factors in the development of type 2 diabetes. Metformin is a biguanide antihyperglycemic agent that increases peripheral insulin sensitivity, reduces hepatic gluconeogenesis, and decreases intestinal glucose absorption. METHODS: Thirty-one patients (24 women, 7 men; mean age, 61.8 years; mean body mass index [BMI], 28.0 kg/m2) were enrolled in this randomized, double-blind, 2-way, crossover, placebo-controlled study. Patients with type 2 diabetes who were treated previously with insulin or oral hypoglycemic agents and who had a glycosylated hemoglobin (HbA1c) level >9% or a fasting blood glucose level >8 mmol/L were included. Patients who were being treated with oral agents were switched to insulin therapy and required to maintain stable blood glucose control for 2 months prior to randomization. Patients received insulin plus either metformin 1,700 mg/d or placebo for 5 months, followed by a 2-month washout period, and were then crossed over to the other treatment arm for 5 months of additional treatment (total treatment period: 12 months). RESULTS: Thirty patients completed the study; 1 patient withdrew early because of hypoglycemia. Compared with placebo, metformin produced significant reductions from overall baseline in mean daily insulin dose requirement (-8.69 units (17.2%], P < 0.001), HbA1c level (-0.74 [9.9%], P = 0.005), serum fructosamine level (-44.40 micromol/L, P = 0.026), 24-hour blood glucose profile (P = 0.008), and total cholesterol level (-0.42 mmol/L, P = 0.005). No treatment effects were observed on body weight, blood pressure, serum high-density lipoprotein cholesterol levels, or serum triglyceride levels. There was no correlation between BMI and reduction in HbA1C. No major side effects were reported. CONCLUSIONS: Combination therapy with metformin and insulin improves glycemic control and reduces insulin requirements. with no major side effects, in patients with type 2 diabetes and may improve the risk profile in this patient population.     

2型糖尿病患者应用二甲双胍时血尿酸水平的变化及其影响因素分析——附480例报告

目的：观察2型糖尿病患者应用二甲双胍时血尿酸水平的变化及其影响因素。方法：对480例长期服用二甲双胍的门诊2型糖尿病患者采用自身对照方法,观察二甲双胍常规使用期（入选时）、停用二甲双胍后（洗脱期）第4周、再度恢复二甲双胍常规使用后（恢复期）第4周的血尿酸水平变化。同时观察其他相关生化指标、年龄、糖尿病病程、血压、体质量指数、二甲双胍日剂量等因素对血尿酸变化的影响。结果：患者入选时、洗脱期、恢复期血尿酸水平分别为（376±90）μmol/L、（355±88）μmol/L、（391±80）μmol/L,入选时、恢复期与洗脱期血尿酸比较差异均有统计学意义（P（0.05）。将480例观察者作为整体,恢复期和洗脱期血尿酸差值作为应变量Y（增高=1;无增高=0）,以年龄、糖尿病病程、洗脱期收缩压、洗脱期舒张压、体质量指数、空腹血糖、ALT、血清肌酐、血尿酸值及二甲双胍日剂量等为自变量（X1-X10）,进行多元逐步Logistic回归分析,先后入选的变量是年龄、洗脱期血尿酸基线值及二甲双胍日剂量。结论：部分2型糖尿病患者服用二甲双胍可引起血尿酸水平轻度升高,血尿酸水平升高可能与高龄、血尿酸基线水平偏高和二甲双胍日剂量偏大有关。     

利拉鲁肽联合二甲双胍治疗肥胖型2型糖尿病的效果及对氧化应激指标的影响

目的 分析利拉鲁肽联合二甲双胍治疗肥胖型2型糖尿病的效果及对氧化应激指标的影响.方法 回顾性选取2019年1月至2021年1月本院收治的96例肥胖型2型糖尿病患者为研究对象,依据治疗方法将其分为利拉鲁肽联合二甲双胍治疗组(联合治疗组)和二甲双胍单独治疗组(单独治疗组),各48例.比较两组患者的BMI、血糖指标、临床疗效...     

Effect of repaglinide addition to metformin monotherapy on glycemic control in patients with type 2 diabetes.

OBJECTIVE: To compare the effect of repaglinide in combination with metformin with monotherapy of each drug on glycemic control in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 83 patients with type 2 diabetes who had inadequate glycemic control (HbA1c > 7.1%) when receiving the antidiabetic agent metformin were enrolled in this multicenter, double-blind trial. Subjects were randomized to continue with their prestudy dose of metformin (n = 27), to continue with their prestudy dose of metformin with the addition of repaglinide (n = 27), or to receive repaglinide alone (n = 29). For patients receiving repaglinide, the optimal dose was determined during a 4- to 8-week titration and continued for a 3-month maintenance period. RESULTS: In subjects receiving combined therapy, HbA1c was reduced by 1.4 +/- 0.2%, from 8.3 to 6.9% (P = 0.0016) and fasting plasma glucose by 2.2 mmol/l (P = 0.0003). No significant changes were observed in subjects treated with either repaglinide or metformin monotherapy in HbA1c (0.4 and 0.3% decrease, respectively) or fasting plasma glucose (0.5 mmol/l increase and 0.3 mmol/l decrease respectively). Subjects receiving repaglinide either alone or in combination with metformin, had an increase in fasting levels of insulin between baseline and the end of the trial of 4.04 +/- 1.56 and 4.23 +/- 1.50 mU/l, respectively (P < 0.02). Gastrointestinal adverse events were common in the metformin group. An increase in body weight occurred in the repaglinide and combined therapy groups (2.4 +/- 0.5 and 3.0 +/- 0.5 kg, respectively; P < 0.05). CONCLUSIONS: Combined metformin and repaglinide therapy resulted in superior glycemic control compared with repaglinide or metformin monotherapy in patients with type 2 diabetes whose glycemia had not been well controlled on metformin alone. Repaglinide monotherapy was as effective as metformin monotherapy.     

Metabolic and hemodynamic effects of pioglitazone in obese patients with type 2 diabetes

The purpose of the study was to evaluate the effectiveness and safety of pioglitazon, a hypoglycemizing preparation belonging to the group of thiazolidinediones, in treatment of diabetes mellitus (DM) type 2. Twenty DM type 2 patients were included in the study. The use of pioglitazon during 12 weeks resulted in a significant decrease in glycated hemoglobin, fasting glycemia, and postprandial reduction in insulinemia and insulinoresistance index HOMA-IR, as well as an improvement of lipid blood spectrum and the lessening of visceral obesity. Besides, a positive effect on arterial pressure was noted. The study revealed no significant adverse effects; good tolerance to treatment was noted in 90% of the patients.