比较达格列净片与西格列汀对2型糖尿病合并慢性心力衰竭患者血糖水平及心功能的影响

目的 比较2型糖尿病合并慢性心力衰竭患者给予达格列净片与西格列汀治疗对血糖水平及心功能的影响.方法 选取在本院治疗的2型糖尿病合并慢性心力衰竭患者86例,选取时间在2018年6月至2021年1月,按照随机数字表法分成观察组(n=43)和对照组(n=43),对照组采用西格列汀进行治疗,观察组采用达格列净片进行治疗,比较两...     

西格列汀联合阿卡波糖治疗Ⅱ型糖尿病对脂代谢紊乱与胰岛素抵抗的影响

【摘要】目的 探讨西格列汀联合阿卡波糖治疗Ⅱ型糖尿病及对脂代谢紊乱与胰岛素抵抗的影响。方法 118例Ⅱ型糖尿病患者依据抽签法分为对照组与实验组，各59例。对照组采用西格列汀治疗，实验组采用西格列汀联合阿卡波糖治疗。比较两组治疗3个月后疗效，并检测三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白（HDL-C）、低密度脂蛋白（LDL-C），胰岛素抵抗指数（HOMA IR），血糖，胃肠激素，炎症因子的改变及不良反应情况。结果〓实验组总有效率高于对照组，差异有统计学意义（P＜0.05）。实验组TG、TC、LDL-C均低于对照组，实验组HDL-C高于对照组（P＜0.05）。实验组HOMA IR低于对照组（P＜0.05）。实验组血糖、胃肠激素、炎症因子优于对照组（P＜0.05）。两组不良反应比较差异无统计学意义（P＞0.05）。结论〓西格列汀联合阿卡波糖用于Ⅱ型糖尿病的疗效肯定，可改善脂代谢紊乱及胰岛素抵抗，并可利于胃肠道激素及炎性因子的调节，可在临床上推广应用。     

Safety and efficacy of adding sitagliptin to insulin in patients with type 2 diabetes: The ASSIST-K study

We retrospectively studied more than 1000 patients with type 2 diabetes attending 36 Japanese clinics to investigate the efficacy and safety of adding sitagliptin to various insulin regimens. We found that the treatment with add-on sitagliptin for 6-months was effective, irrespective of the type or dose of concomitant insulin.     

Comparison of the efficacy of sitagliptin and glimepiride dose‐up in Japanese patients with type 2 diabetes poorly controlled by sitagliptin and glimepiride in combination

Aims/Introduction

The goal of the study was to examine the effects of sitagliptin dose‐up or glimepiride dose‐up in Japanese patients with type 2 diabetes who were controlled inadequately by sitagliptin and glimepiride in combination.

Materials and Methods

A multicenter, prospective, randomized, open‐label study was carried out in 50 patients with type 2 diabetes treated with sitagliptin and low‐dose glimepiride. The patients were randomly assigned to receive the addition of 50 mg/day sitagliptin or 0.5 mg/day glimepiride. The primary end‐point was the percentage change in glycated hemoglobin (HbA1c).

Results

During a follow‐up period, the difference in the percentage changes in HbA1c between the two groups was not significant (P = 0.13). However, HbA1c was significantly decreased by glimepiride dose‐up (P < 0.01 vs baseline), but not by sitagliptin dose‐up (P = 0.74). Univariate linear regression analyses showed that the percentage change in HbA1c was significantly associated with the serum level of arachidonic acid (AA) in both groups.

Conclusions

There was no significant difference in the HbA1c‐lowering effects between the two groups. However, a significant HbA1c‐lowering effect from baseline of glimepiride dose‐up was found, and the AA level showed a negative correlation with the decrease in HbA1c in the sitagliptin dose‐up group, but a positive correlation in the glimepiride dose‐up group. These findings suggest that the AA level is associated with HbA1c reduction in response to dose‐up with these drugs in patients with type 2 diabetes in a combination therapy with sitagliptin and glimepiride. This trial was registered with UMIN (no. 000009544).     

Factors influencing the durability of the glucose‐lowering effect of sitagliptin combined with a sulfonylurea

We analyzed the changes of glycemic control over 12 months and the factors influencing blood glucose in 162 Japanese patients with type 2 diabetes having inadequate glycemic control despite sulfonylurea‐based therapy who received add‐on sitagliptin. Hemoglobin A1c (HbA1c) decreased significantly after 4 weeks of treatment, and this improvement was maintained for 1 year, although HbA1c was slightly higher in week 52 than in week 24. Comparison of the patients showing a ≥0.4% increase of HbA1c between weeks 24 and 52 (n = 57) with the others (n = 105) showed a significant difference in the change of bodyweight, as well as the dose of glibenclamide (both P < 0.01). Although combined therapy with sitagliptin and a sulfonylurea seems to be effective for at least 1 year, blood glucose levels are more likely to increase again in patients who show greater weight gain after 24 weeks of treatment and those receiving a higher dose of glibenclamide.     

Efficacy and safety of sitagliptin in Japanese patients with type 2 diabetes switched from glinides

Aims/Introduction

The efficacy and safety of sitagliptin, a dipeptidyl peptidase (DPP)‐4 inhibitor, were compared with those of glinides in Japanese patients with type 2 diabetes.

Materials and Methods

The participants were 82 patients with type 2 diabetes (glycated hemoglobin [HbA1c] ≥6.0% and <10%) under treatment with glinides for glucose control. The participants were randomly assigned to a group (n = 44) receiving continuous treatment with glinides and a group (n = 38) switched to sitagliptin. Patients were followed for 12 weeks to evaluate glucose control. A meal tolerance test was carried out in weeks 0 and 12 to examine the pancreatic secretory response to postprandial hyperglycemia.

Results

The changes in HbA1c from week 0 to week 12 were −0.25 and −0.05% in the sitagliptin and glinide groups, respectively, with a significant improvement with sitagliptin. The differences in fasting plasma glucose (FPG), glycoalbumin and 1,5‐anhydroglucitol between the two groups were 14.2 mg/dL, 0.7% and 1.7 μg/mL, respectively, showing significant improvements with sitagliptin. In the meal tolerance test, glucose at 0 min was lower in the sitagliptin group; however, there were no differences in glucose elevation at 30 and 60 min compared with 0 min. Plasma insulin and glucagon secretion at week 12 were significantly lower than at baseline in the sitagliptin group. Adverse events including hypoglycemia did not differ between the groups.

Conclusions

FPG decreased and glucose control improved in patients who switched from glinides to sitagliptin. Sitagliptin decreased secretion of insulin and glucagon in a meal tolerance test compared with glinides, whereas the agents showed similar inhibition of postprandial hyperglycemia. This trial was registered with UMIN (UMIN‐CTR no. 000003479).     

西格列汀联合预混胰岛素治疗脆性糖尿病伴高脂血症疗效

目的分析西格列汀联合预混胰岛素治疗脆性糖尿病伴高脂血症的疗效。方法按照随机抽样的方式,从该院2018年3月—2019年3月的脆性糖尿病伴高脂血症患者中,选取110例作为研究对象。对患者的临床资料进行整理,确定其完备性后,按照双色球分组的方式将其划分为两组——对照组(n=55)和观察组(n=55),前者采取单纯的预混胰岛素治疗,后者采取西格列汀联合预混胰岛素治疗。对两组患者治疗前、持续用药12周以后的血糖指标与血脂指标进行观察。结果两组患者治疗前的血糖指标与血脂指标比较,差异无统计学意义(P>0.05);在治疗后,观察组患者与对照组患者的血糖指标与血脂指标相比较,差异有统计学意义(P<0.05)。结论西格列汀联合预混胰岛素治疗脆性糖尿病伴高脂血症的临床效果较好,能够对患者的血糖与血脂水平进行调整,且安全性较高,值得推广。     

磷酸西格列汀治疗老年2型糖尿病合并冠心病的临床疗效研究

目的 观察磷酸西格列汀对合并冠心病（coronary heart disease,CHD）的老年2型糖尿病（type 2 diabetes,T2DM）患者各项指标的影响.方法 40例合并CHD的老年T2DM患者在原有治疗的基础上联合磷酸西格列汀治疗,治疗前及治疗4m后分别检测空腹血糖（fast plasma glucose,FPG）、餐后2h血糖（postprandial blood glucose,PBG）、糖化血红蛋白（HbA1c）、血清总胆固醇（total cholesterol,TC）、三酰甘油（triglyceride,TG）;超声心动图检测患者左房（left atrium,LA）、左室（left ventriculus,LV）大小,射血分数（ejection fraction,EF）,24 h血压监测（ambulatory blood pressure monitoring,ABPM）,并比较各项指标的变化.结果 磷酸西格列汀治疗4m后,患者的FPG、PBG、HbA1c值均下降（P＜0.01、P＜0.05和P＜0.01）.治疗后TC无明显变化（P＞0.05）,TG下降（P＜0.05）.LA、LV与治疗前相比无变化（P＞0.05）,EF有所改善（P＜0.05）.治疗期间患者体重差异无统计学意义（P＞0.05）,且无心血管不良反应发生.结论 在合并CHD的老年T2DM患者中应用磷酸西格列汀治疗后,有明确的降糖效果,对心功能无不良反应,还能对患者的TG、EF、BP有轻度的改善作用,可能对患者的预后有益.     

甘精胰岛素联合西格列汀对首诊2型糖尿病血糖波动炎症因子及低血糖事件的影响

目的 探讨甘精胰岛素联合西格列汀对首诊2型糖尿病（T2DM）患者血糖波动、炎症因子及低血糖事件的影响。方法 选择2017年6月至2018年10月在无锡市第三人民医院接受治疗的124例首诊T2DM患者为研究对象,采用随机数字表法分为对照组与观察组,每组62例。对照组给予甘精胰岛素联合瑞格列奈治疗,观察组给予甘精胰岛素联合西格列汀治疗。比较两组患者空腹血糖（FBG）、餐后2 h血糖（2 h PBG）、糖化血红蛋白（HbA1c）、日内血糖平均波动幅度（MAGE）、日内血糖波动次数（NGE）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、C反应蛋白（CRP）、体质指数（BMI）,以及低血糖发生率和甘精胰岛素用量的差异。结果 观察组患者治疗后的MAGE为（2.53±1.19）mmol/L、NGE为（1.53±0.93）mmol/L,均低于对照组,差异有统计学意义（P<0.05）。两组患者治疗前与治疗后MAGE、NGE的差值进行比较,差异有统计学意义（P<0.05）。观察组患者治疗后的血清CRP水平为（2.76±1.03）mg/L、TNF-α为（19.83±8.41）ng/L、IL-6为（18.61±4.73）ng/L,均低于对照组,差异有统计学意义（P<0.05）。两组患者治疗前与治疗后血清CRP、TNF-α、IL-6差值进行比较,差异有统计学意义（P<0.05）。观察组患者治疗后的BMI为（23.24±2.83）kg/m²,对照组为（24.29±3.05）kg/m²,差异有统计学意义（P<0.05）。观察组患者低血糖发生率为1.60%、甘精胰岛素用量为（25.54±5.09）U/d,均低于对照组,差异有统计学意义（P<0.05）。结论 甘精胰岛素联合西格列汀能够减少血糖波动,减轻机体微炎症反应,减少低血糖发生率和甘精胰岛素用量。     

口服二甲双胍血糖控制不佳的2型糖尿病患者联合西格列汀治疗的有效性和安全性

目的评价口服二甲双胍血糖控制不佳的2型糖尿病患者联合西格列汀治疗的有效性与安全性。方法采用随机、开放、格列美脲平行对照的研究方法。102例口服二甲双胍控制不佳的2型糖尿病患者随机分为早餐前口服西格列汀100 mg（n=52）或早餐前口服格列美脲1~4 mg（n=50）两组,同时继续口服二甲双胍,进行为期24周的观察。结果①基线时两组口服二甲双胍的时间及其他指标相似;②24周时,西格列汀组与格列美脲组的平均HbA1c分别下降了1.41%和1.38%,日平均血糖降幅分别为5.28 mmol/L和4.56 mmol/L;③试验结束时,西格列汀组和格列美脲组分别有3.80%和10.00%的患者发生症状性低血糖（3次和18次）,其中严重低血糖事件,西格列汀组为0次,格列美脲组有4.00%患者（3次）,夜间低血糖西格列汀组为0次,格列美脲组有4.00%患者（2次）,两组间差异有统计学意义（均P〈0.05）;④试验结束时西格列汀组患者平均体重下降1.0 kg,格列美脲组平均增加1.2 kg,两组间差异有统计学意义（P〈0.01）。结论与格列美脲相比,西格列汀联合二甲双胍可使2型糖尿病患者的血糖得到有效控制,且低血糖发生率明显降低,体重下降;因此,作为控制2型糖尿病血糖的二线用药,西格列汀优于格列美脲。