西格列汀联合甘精胰岛素对2型糖尿病患者血糖水平影响观察

摘 要 目的:观察西格列汀联合甘精胰岛素对2型糖尿病患者血糖水平的影响,以及临床疗效和安全性。方法：66例2型糖尿病患者随机分为观察组和对照组,分别给予西格列汀联合甘精胰岛素治疗和预混胰岛素治疗3个月。比较两组患者治疗前后的血糖水平变化,以及血压血脂等指标变化。评价两组临床疗效和药品不良反应。结果：除低血糖AUC外,观察组患者治疗后的空腹血糖、餐后2 h血糖、糖化血红蛋白,以及72 h内平均血糖水平、血糖水平标准差、日内血糖平均波动幅度、日内血糖平均绝对差、日内血糖波动次数、高血糖AUC等血糖指标均较前明显改善（P<0.05）,且优于对照组（P<0.05）。两组患者治疗前后血压、血脂无显著变化（P>0.05),观察组治疗后BMI低于对照组（P<0.05）。两组总有效率比较差异无统计学意义（P>0.05)。观察组药品不良反应发生率显著低于对照组（P<0.05）。结论：西格列汀联合甘精胰岛素能显著降低2型糖尿病患者的血糖水平,疗效确切,安全性高,建议临床推广。     

西格列汀联合胰岛素对老年2型糖尿病患者血糖波动系数及低血糖发生率的影响

目的 观察西格列汀联合胰岛素对老年2型糖尿病患者血糖波动系数及低血糖发生率的影响.方法 选取2018年10月-2019年6月广州市白云区人民医院内二科接诊的老年2型糖尿病患者100例,根据治疗方案的不同分为观察组与对照组各50例.对比2组治疗前后血糖、胰岛功能指标、血糖波动情况及低血糖发生率.结果 治疗后,2组空腹血糖...     

甘精胰岛素治疗2型糖尿病对患者24 h动态血糖的影响

目的 观察甘精胰岛素治疗2型糖尿病对患者24 h动态血糖的影响。方法 选取2019年1月—2020年12月福建省龙海市第一医院收治的2型糖尿病患者110例,采用随机数字表法分为联合组和二甲双胍组,每组55例。二甲双胍组患者采用二甲双胍治疗,联合组患者在二甲双胍组的基础上联合甘精胰岛素治疗,2组均连续治疗3个月。比较2组患者的治疗效果、治疗前后血糖波动情况[24 h血糖平均绝对差(MODD)、24 h血糖波动次数(NGE)、平均血糖波动幅度(MAGE)及血糖标准差(SDBG)]、糖耐量情况[空腹胰岛素(FINS)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA_1c)]及氧化应激反应指标[超氧化物岐化酶(SOD)、丙二醛(MDA)、血清活性氧(ROS)]。结果 联合组患者的总有效率为96.4%,高于二甲双胍组的83.6%(χ²=4.949,P=0.026)。治疗3个月后,2组患者MODD、NGE、MAGE及SDBG均低于治疗前,且联合组低于二甲双胍组(P均<0.01);2组患者FINS高于治疗前,2 hPG、HbA_1c     

西格列汀联合早期胰岛素泵强化治疗对初诊2型糖尿病患者的影响

目的:分析西格列汀联合早期胰岛素泵强化治疗对初诊2型糖尿病患者的影响.方法:2018-03～2020-09选取济源市卫校附属医院初诊2型糖尿病患者402例,依照随机数字表法分为观察组、对照组.对照组(n=201)接受早期胰岛素泵强化治疗,观察组(n=201)接受西格列汀联合早期胰岛素泵强化治疗,比较两组血糖达标时间、治疗前后血糖水平[糖化血红蛋白(HbAlc)、空腹血糖(FPG)、餐后2h血糖(2hPG)]、血脂水平[三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)]、血清胰高血糖素样肽-1(GLP-1)、脂联素(APN)、不良反应(呕吐、腹胀、腹泻、恶心、皮肤瘙痒).结果:与对照组对比,观察组血糖达标时间较短(P＜0.05);治疗后,两组血糖水平均有所改善,且观察组HbAlc、FPG、2hPG均低于对照组(P＜0.05);治疗后,两组血脂水平均有所降低,且观察组TG、TC、LDL-C水平均低于对照组(P＜0.05);治疗后,两组血清GLP-1、APN均有所升高,且观察组高于对照组(P＜0.05);两组呕吐、腹胀、腹泻、恶心、皮肤瘙痒发生率对比,无统计学意义(P＞0.05).结论:初诊2型糖尿病患者接受西格列汀联合早期胰岛素泵强化治疗,能缩短血糖达标时间,有效控制血糖水平,降低血脂水平,提高血清GLP-1、APN水平,且安全性高.     

血糖控制情况对2型糖尿病患者动态血糖波动的分析

目的观察分析血糖控制情况对2型糖尿病患者动态血糖波动状况。方法选择2011年9月至2013年7月来我院治疗的糖化血红蛋白控制在7以内的2型糖尿病患者有58例,对所有患者均进行72 h的连续动态血糖监测(CGMS),依据血糖谱分析其血糖波动情况。结果本研究组中有28例2型糖尿病患者(糖化血红蛋白控制在7以内)在每餐后出现显著的血糖升高现象,特别是在早餐后更为明显,患者的血糖峰值出现在早餐后的1.6 h;且血糖>14.0、11.2、7.9 mmol/L所占的时间百分比分别为7%、15%、26%;患者的72 h CGMS中血糖>7.9 mmol/L曲线下的面积与糖化血红蛋白值呈正相关。另有20例患者出现低血糖,且多发生于凌晨3点左右,多为无症状性低血糖,只有2例患者出现了低血糖反应。结论血糖情况控制较好的2型糖尿病患者也会出现较明显的高血糖情况,72 h的连续动态血糖监测血糖谱能够比较直观的反映患者的总体血糖控制情况和动态血糖波动细节的信息,对进一步调整治疗方案提供了关键信息。     

西格列汀联合预混胰岛素治疗血糖控制不佳2型糖尿病患者的临床研究

目的 探讨西格列汀联合预混胰岛素治疗血糖控制不佳2型糖尿病(T2DM)患者的有效性及安全性.方法 选取胰岛素治疗不佳的T2DM患者72例,随机分为对照组35例和试验组37例,试验组加用西格列汀口服.治疗12周后比较两组患者的糖化血红蛋白(HbA1c)、血糖变异度、胰岛素用量、低血糖事件、体重指数(BMI).结果 与对照组相比,试验组HbA1c下降[(7.1±0.9)％vs.(7.8±1.1)％,P＜ 0.05]、血糖变异度减低[(0.24±0.09) vs.(0.35±0.12),P＜0.05]、胰岛素用量减少[(0.38±0.27) U/(kg·d)vs.(0.51±0.35) U/(kg·d),P＜0.05],低血糖事件减少[(0.90±0.40) vs.(2.10±1.20),P＜0.05],BMI无明显变化[(25.10±2.90) kg/m2 vs.(26.70±4.40) kg/m2,P＞0.05].结论 西格列汀联合预混胰岛素治疗T2DM患者安全且更加有效.     

西格列汀治疗老年2型糖尿病的临床观察

目的观察西格列汀(SITA)治疗2型糖尿病(T2DM)的临床疗效。方法将79例T2DM患者随机分为2组,A组39例单纯采用胰岛素治疗,B组40例采用SITA治疗,观察两组餐后2 h血糖(2hPG)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、体重指数(BMI)及胰岛素分泌指数(HOMA-B)的变化。结果治疗8周后,B组2hPG、FPG、HbA1c、胰岛素用量及BMI均低于A组(P<0.05),HOMA-B高于A组(P<0.05)。结论SITA治疗T2DM可有效控制血糖,减少胰岛素用量,改善胰岛β细胞功能。     

2型糖尿病患者24小时动态血压的临床观察

本研究对119例2型糖尿病患者合并高血压和单纯高血压患者，进行了24h动态血压监测（ABPM），目的在于了解2型糖尿病患者24h血压波动情况，从而指导治疗。     

西格列汀联合胰岛素对2型糖尿病患者HOMA-β、HOMA-IR水平的影响

目的:探讨2型糖尿病患者采用西格列汀与胰岛素联合治疗对胰岛素分泌指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)水平的影响.方法:选择2018年2月—2019年3月我院就诊的2型糖尿病患者80例,采用随机数字表法分为2组,各40例.对照组给予胰岛素治疗,观察组给予西格列汀与胰岛素联合治疗,比较两组胰岛素功能及血糖...     

动态血糖监测评估血糖控制良好的2型糖尿病患者的血糖波动

目的 动态监测血糖控制良好的2型糖尿病患者的血糖波动状况. 方法 采用动态血糖监测系统对42例HbA1c＜6.5%的2型糖尿病患者进行连续3 d血糖监测. 结果 42例患者中,12例（28.6%）发生低血糖（血糖≤3.0 mmol/L）,其中8例低血糖发生于凌晨0：00～3：59,4例为无症状低血糖;18例（42.9%）发现高血糖（血糖＞11.1 mmol/L）,17例发生于三餐后. 结论 血糖控制良好的2型糖尿病患者,动态血糖监测系统可发现有高血糖和无症状性低血糖存在,为合理的治疗方案提供临床依据.     

基于动态血糖监测系统探讨短期持续胰岛素皮下输注在老年2型糖尿病患者中的应用价值

目的应用动态血糖监测系统(CGMS)评估老年2型糖尿病(T2DM)患者在短期持续胰岛素皮下输注(CSII)治疗前后的血糖控制水平及波动性变化,探讨CSII在老年T2DM患者中的应用价值。方法纳入2018年10月至2019年10月在我院住院的老年T2DM患者39例,所有研究对象在入组前3 d均维持院外降糖治疗方案,同时佩戴CGMS,记录日间平均血糖水平(MBG)、血糖达标时间(TIR)、低血糖曲线下面积(AUC3.9)、高血糖曲线下面积(AUC10.0)、平均血糖波动幅度(MAGE)、血糖标准差(SDBG)、血糖变异系数(CVBG)、最大血糖波动幅度(LAGE)、日间血糖平均绝对差(MODD)等指标,作为基线水平;第4天开始停用原降糖药物并启动CSII治疗,2周后再次佩戴CGMS,记录上述指标,比较在CSII治疗前后各研究对象的血糖变化情况。结果与CSII治疗前相比,CSII治疗后MBG明显下降[(8.27±1.79)mmol/L vs.(9.85±2.30)mmol/L,P<0.01]、TIR显著增加(75.69%±31.96%vs.58.62%±33.23%,P<0.01);CSII治疗前共发生低血糖事件3次,低血糖曲线下面积AUC3.9为(0.37±0.81)h·mmol/L,CSII治疗后未发生低血糖事件(AUC3.9=0)(P=0.007);高血糖曲线下面积AUC10.0在CSII治疗前后比较差异有统计学意义[(19.55±24.29)h·mmol/L vs.(5.87±8.36)h·mmol/L,P<0.01]。CSII治疗后MAGE[(2.88±1.34)mmol/L vs.(5.35±3.25)mmol/L]、SDBG[(1.23±0.65)mmol/L vs.(1.82±0.78)mmol/L]、CVBG[(14.99±6.62)mmol/L vs.(20.22±9.97)mmol/L]、LAGE[(5.14±2.43)mmol/L vs.(8.02±4.20)mmol/L]、MODD[(0.70±0.38)mmol/L vs.(1.59±1.08)mmol/L]均较CSII治疗前显著减小(P<0.01)。结论对于老年T2DM患者,CSII与常规降糖治疗方案相比,其血糖控制水平更佳、低血糖风险更低、血糖波动性更小。     

动态血糖监测在肥胖2型糖尿病患者运动饮食中的价值

目的：观察动态血糖监测系统（CGMS）指导肥胖2型糖尿病（T2DM）运动饮食的价值。方法：92例患者随机分为两组,分别应用CGMS和指尖血糖监测血糖,检测体重、空腹血糖、三酰甘油及糖化血红蛋白,前后自身对照及组间比较评价CGMS的效果。结果：两组患者体重、空腹血糖、三酰甘油及糖化血红蛋白较前均降低,差异有统计学意义（P〈0.05）,CGMS组体重、血糖、三酰甘油及糖化血红蛋白较对照组降低明显,差异有统计学意义（P〈0.05）。结论：CGMS有助于肥胖2型糖尿病患者较为准确地掌握饮食、运动知识,更有针对性地指导患者的生活习惯。     

A cyclic fluctuation model for 24-h ambulatory blood pressure monitoring in Chinese patients with mild to moderate hypertension

Aim:

The conventional method for analyzing 24-h ambulatory blood pressure monitoring (24-h ABPM) is insufficient to deal with the large amount of data collected. The aim of this study was to develop a novel cyclic fluctuation model for 24-h ABPM in Chinese patients with mild to moderate hypertension.

Methods:

The data were obtained from 4 independent antihypertensive drug clinical trials in Chinese patients with mild to moderate hypertension. The measurements of 24-h ABPM at the end of the placebo run-in period in study 1 were used to develop the cyclic fluctuation model. After evaluated, the structural model was used to analyze the measurements in the other 3 studies. Models were fitted using NONMEM software.

Results:

The cyclic fluctuation model, which consisted of 2 cosine functions with fixed-effect parameters for rhythm-adjusted 24-h mean blood pressure, amplitude and phase shift, successfully described the blood pressure measurements of study 1. Model robustness was validated by the bootstrap method. The measurements in the other 3 studies were well described by the same structural model. Moreover, the parameters from all the 4 studies were very similar. Visual predictive checks demonstrated that the cyclic fluctuation model could predict the blood pressure fluctuations in the 4 studies.

Conclusion:

The cyclic fluctuation model for 24-h ABPM deepens our understanding of blood pressure variability, which will be beneficial for drug development and individual therapy in hypertensive patients.     

Fulminant type 1 diabetes: The clinical and continuous glucose monitoring characteristics in Chinese patients

The purpose of the current study was to investigate the clinical characteristics of fulminant type 1 diabetes mellitus (FT1DM) in Chinese patients and to further determine their glycaemic profiles through continuous glucose monitoring (CGM). Thirty subjects who were diagnosed with FT1DM according to the 2012 JDS criteria were enrolled. Clinical characteristics were compared to those reported in Japanese FT1DM. All subjects received retrospective CGM for 3 days after being converted to subcutaneous insulin injection therapy. Chinese FT1DM patients presented with a shorter duration of symptoms (2.84 ± 2.42 days vs 4.4 ± 3.1 days, P < 0.01), worse islet function (fasting C‐peptide, 0.09 ± 0.11 ng/mL vs 0.30 ± 0.21 ng/mL; 2‐hour C‐peptide, 0.13 ± 0.14 ng/mL vs 0.30 ± 0.30 ng/mL, both P < 0.01), lower prevalence of flu‐like symptoms (46.7% vs 71.4%, P < 0.05), and a significantly higher GADA positive rate (23.3% vs 5.1%, P < 0.01) when compared with Japanese patients. The CGM results showed that the mean time in range (TIR) of FT1DM patients was 49.8 ± 22.1%, while mean amplitude of glycaemic excursion (MAGE) and standard deviations of sensor glucose (SDSG) were 7.58 ± 3.59 mmol/L and 3.19 ± 1.22 mmol/L, respectively, with nearly 1/3 participants coefficient of variation (CV) > 36% (all are male), suggesting a large glucose fluctuation. The female patients were further divided into pregnancy‐related FT1DM (PF) and non‐PF (NPF) subgroups (both n = 5), and we found that PF patients had a significantly higher TIR than NPF patients (77.0 ± 16.1% vs 41.0 ± 22.4%, P < 0.05). There were heterogeneities in the clinical characteristics of FT1DM patients, and the CGM results indicated a very low TIR and large glucose fluctuation which needs careful attention.     

新诊断的2型糖尿病患者胰岛素泵治疗前后血糖的动态变化

目的观察新诊断的2型糖尿病（T2DM）患者胰岛素泵治疗前后血糖漂移变化特征,评估胰岛素泵强化控制血糖的疗效。方法选取新诊断的T2DM患者38例,随机分为胰岛素泵治疗组（csⅡ）18例,胰岛素多次皮下注射组（MSⅡ）20例,对其治疗前后采用动态血糖监测系统（CGMS）进行连续3d的血糖监测,进行自身前后对照和组间对照分析。结果两组患者经2周治疗后糖代谢紊乱明显缓解,38例治疗前后全天平均血糖（MBG）、日内血糖平均波动幅度（MAGE）、日伺血糖平均绝对差（MODD）比较差异均有统计学意义（P〈0．001）;治疗后血糖〉7．8mmol／L和〉11．1mmol／L所占13内时间百分比与治疗前比较均有显著降低（P〈0．001）;治疗后餐前及餐后各时段的平均血糖水平亦显著下降（P〈0．05,P〈0．01）。上述各项血糖参数csⅡ组均优于MSⅡ组（P〈0．01,P〈0．001）。结论动态血糖监测能评估血糖漂移变化特征,胰岛素泵为强化控制血糖的有效方法。．     

Efficacy of mitiglinide and sitagliptin,alone or in combination,on postprandial excursion and glycemic variability assessed by continuous glucose monitoring: a post hoc analysis with single-day treatment

Objective: To compare the efficacy of mitiglinide and sitagliptin, alone or in combination, on postprandial excursion and glycemic variability assessed by continuous glucose monitoring (CGM) in a single-day treatment setting.

Methods: This was a post hoc analysis of a randomized crossover study comparing the efficacy of sitagliptin, mitiglinide and the combination of these two drugs. Twenty-four hour CGM was performed before and after a single-day treatment with each drug alone or in combination.

Results: Mean glucose levels were decreased in all groups. The average of three postprandial glucose excursions AUC (average of all three 4-h postprandial periods throughout the day) (AUCpp-average) decreased in the mitiglinide and combination treatment groups, but not in the sitagliptin group. The lowering effect on AUCpp-average was greater in patients given mitiglinide (–47 mg/dl, p < 0.001) or combination treatment (–66 mg/dl, p < 0.001) compared with sitagliptin alone (–18 mg/dl). The reduction in mean amplitude of glycemic excursion was greater with mitiglinide (–29.3 mg/dl, p < 0.001) and combination treatment (–28.3 mg/dl, p < 0.01) than with sitagliptin alone (–8.9 mg/dl).

Conclusions: Mitiglinide or combination treatment resulted in lower glycemic variability and postprandial glucose excursion than sitagliptin alone; however, the results of this single-day pharmacodynamics study cannot be generalized to a clinical setting.     

磷酸西格列汀联合胰岛素治疗2型糖尿病疗效观察

目的 观察磷酸西格列汀联合胰岛素治疗2型糖尿病的临床疗效.方法 选取在我院接受胰岛素治疗至少8周的2型糖尿病患者20例,入选后测定身高、体重、空腹及餐后血糖、糖化血红蛋白值,记录胰岛素用量.给予磷酸西格列汀100mg/d口服,并根据定期血糖监测情况适时调整胰岛素用量,经过4周联合治疗后,观察患者BMI、空腹及餐后血糖、糖化血红蛋白值的变化.结果 联合磷酸西格列汀治疗4周后,患者HbA1c、FBG显著降低(P＜0.01);2hBG明显降低(P＜0.05);胰岛素用量较前明显减少(P＜0.01);BMI较前无明显改变(P＞0.05).结论 磷酸西格列汀联合胰岛素治疗2型糖尿病有明显疗效,且可以减少患者胰岛素用量,降低低血糖风险,降低体重,无明显胃肠道不良反应.     

An overview and commentary on retrospective,continuous glucose monitoring for the optimisation of care for people with diabetes

ABSTRACT

Introduction: Normoglycaemia in people with diabetes results in improved outcome. Continuous glucose monitoring provides detailed diagnostic information used to optimise therapy with the goal of achieving normoglycaemia. The objective of this study was to review the published literature evaluating the single device available for blinded, professional clinical use of continuous glucose monitoring; in particular all randomised controlled trials (RCTs) and relevant observational studies.

Methods: Published studies (to 31 March 2009) using the Medtronic MiniMed Continuous Glucose Monitoring System (CGMS® System Gold?, Medtronic MiniMed, Inc., Northridge, CA) were identified using appropriate search terms in a series of clinical databases including: Medline, Pubmed, Google Scholar and Scientific Web of Knowledge. Other measures were also taken such as reviewing the reference lists.

Findings: In addition to an extensive range of non-randomised studies using the device, seven randomised controlled trials were identified, of which five were in children. Although HbA1c was explicitly stated as the primary endpoint in four studies, the studies were only adequately powered to detect large, between-group minimum differences (range 0.5 to 1.0% HbA1c). Only two studies included subjects with type 2 diabetes. Other endpoints included the frequency of hypoglycaemia and hyperglycaemia. Within-group HbA1c decreases were observed in all but one study. The crude, weighted mean improvement in HbA1c across the studies using the device was 0.6% (range 0% to 0.8%). When compared to a control measure the weighted, mean marginal benefit in HbA1c was 0.2%. No studies recorded how the information was utilised to modify treatment, such as changes in dose titration or treatment regimen.

Conclusions: Devices such as the professional CGMS provide detailed diagnostic information. However, any consequent changes in care and outcome can only result from the appropriate application of this information. Although there was a notable improvement in glucose control (HbA1c), existing studies were largely underpowered and did not capture the resulting treatment changes that could lead to improved outcome.     

连续动态血糖监测在2型糖尿病中的临床价值

目的应用动态血糖监测系统（CGMS）研究2型糖尿病（T2DM）强化治疗过程中低血糖发生的特征。方法采用动态血糖监测系统（CGMS）对50例使用胰岛素治疗的HbA1c〈7．0％的2型糖尿患者进行连续3d的血糖监测。结果本组患者血糖42．8mmol/L（低血糖）占3．3％,但以21：00-24：00最多,0-3：00点次之。血糖在2．9-7．8mmol/L之间占71．3％,血糖在2．9-10．0mmol/L之间占89％,血糖〉10mmol/L（血糖控制不良）占7．7％,各时段均能见到,以6：00-12：00为多。探头监测到低血糖患者27例,低血糖的发生率为54．0％（27／50）。21：00-3：00（定义为夜间）低血糖的发生率为66．7％（18／27）。结论CGMS能及时准确地发现低血糖,了解低血糖的影响因素及低血糖后的反应,以指导临床治疗,制定针对性的临床治疗方案。