Home blood glucose monitoring in non-insulin-dependent diabetics: the effect of gliclazide on blood glucose and weight control, a multicentre trial

The efficacy of the sulphonylurea gliclazide was assessed in 229 non-insulin-dependent diabetics attending U.K. outpatient diabetic clinics. Patients inadequately controlled by diet alone or oral hypoglycaemic agents used reflectance meters to monitor their blood glucose. After a 4-week run-in, in those whose control remained unsatisfactory, gliclazide was either added to diet, or given in place of existing drugs. Patients continued home-monitoring and were followed for 3 months. Gliclazide reduced mean random blood glucose in all groups, particularly those previously treated by diet alone or a first-generation sulphonylurea. The patients improved in their ability to measure glucose at home and within 2 months a good correlation with laboratory measurements was found. Mean body weight was reduced, particularly in obese and elderly subjects and those treated previously with sulphonylurea drugs. Side effects were mild and only two patients were withdrawn for this reason.     

Long-term effects on lipids and lipoproteins of pioglitazone versus gliclazide addition to metformin and pioglitazone versus metformin addition to sulphonylurea in the treatment of type 2 diabetes

Aims/hypothesis The aim of this study was to determine the long-term effects of pioglitazone add-on to metformin or sulphonylurea on plasma lipids and lipoproteins. Materials and methods The effects of pioglitazone were studied in two clinical trials in patients with inadequately controlled type 2 diabetes (HbA₁c ≥7.5 and ≤11%). In the first trial, patients currently receiving metformin were randomised to pioglitazone (15–45 mg/day, n=317) or gliclazide (80–320 mg/day, n=313) add-on therapy. In the second study, pioglitazone (15–45 mg/day, n=319) or metformin (850–2,550 mg/day, n=320) was added to sulphonylurea therapy. Patients were force-titrated to the maximum tolerated dose of add-on therapy, which was maintained to the 2-year endpoint. Results There were no statistically significant differences between the groups with respect to HbA₁c reduction from baseline to week 104. Whether added to metformin or sulphonylurea, pioglitazone caused highly significant greater decreases in triglycerides and increases in HDL cholesterol from baseline to week 104 than treatments with gliclazide or metformin add-on therapies (p≤0.001). The triglyceride reductions noted with pioglitazone were maintained over time, with decreases of 16–18% at 1 year and 17–23% at 2 years. In the pioglitazone groups, the improvement in HDL cholesterol at 1 year was maintained, with 21–22% augmentations at 2 years (p<0.001 between-group difference). Small but statistically significant greater reductions in LDL cholesterol were observed with gliclazide vs pioglitazone add-on to metformin and metformin vs pioglitazone add-on to sulphonylurea (p<0.001 for between-group difference). In the pioglitazone groups, mean LDL cholesterol at 2 years was similar to mean baseline LDL cholesterol. Conclusions/interpretation After 2 years, highly significant decreases in triglycerides and increases in HDL cholesterol that were sustained over time or even improved were observed when pioglitazone was added to metformin or sulphonylurea therapy. These effects of pioglitazone on lipids may be potentially beneficial in reducing cardiovascular risk in type 2 diabetes.     

两种促胰岛素分泌剂对血糖漂移的影响

目的 交叉对比分析瑞格列奈和格列齐特的动态血糖图谱，观察比较血糖波动系数、低血糖发生率和餐后血糖峰值。方法T2DM患者52例，分别应用瑞格列奈或格列齐特，常规检查血糖。采用交叉设计，应用瑞格列奈组患者改用格列齐特，应用格列齐特组患者改用瑞格列奈，改用前后分别予动态血糖监测72h。原有饮食运动及联用口服药物不变。以用瑞格列奈为研究组，用格列齐特为对照组，对比分析两组血糖波动系数、低血糖发生率和餐后血糖峰值。结果经2周洗脱期、8周剂量调整期、2周剂量维持期、3d监测期后的结果显示：应用瑞格列奈比应用格列齐特血糖控制更平稳，动态血糖图谱表现为血糖波动系数小，低血糖次数少，低血糖时间比少（P〈0．01），餐后血糖峰值低（P＜0．05）。结论本研究条件下，应用瑞格列奈比应用格列齐特似可减少血糖漂移幅度。     

Effects of 12-week treatment with dapagliflozin and gliclazide on faecal microbiome: Results of a double-blind randomized trial in patients with type 2 diabetes

Aims/hypothesisPatients with type 2 diabetes (T2D) are usually treated with (combinations of) glucose-lowering medication. The effects of these drugs can be influenced by intestinal microbiota and vice versa, as these drugs can also influence microbiome composition. However, as there is currently little clinical insight into this bug–drug interaction, our study aimed to evaluate the effects of 12-week treatment with the SGLT2 inhibitor dapagliflozin and sulphonylurea gliclazide on gut microbiome composition in T2D patients treated with metformin.MethodsA total of 44 patients were randomized to either dapagliflozin or gliclazide treatment for 12 weeks. At baseline and after 12 weeks, faecal samples and 24-h urine were collected. During study visits, anthropometric data were measured and blood samples drawn after an overnight fast. Microbiome composition was determined by 16S rRNA gene sequencing. Plasma glucose, insulin, HbA_1c and urinary glucose excretion were measured using conventional methods.ResultsWhile dapagliflozin and gliclazide similarly improved glycaemic control, dapagliflozin reduced and gliclazide increased fasting insulin. Dapagliflozin also greatly increased urinary glucose excretion whereas gliclazide did not, while body mass index, fat mass percentage and waist circumference were reduced by dapagliflozin, but increased by gliclazide. However, neither treatment significantly affected either gut microbiome alpha diversity or composition and, after treatment, no associations were found between microbiome composition and other clinical parameters.ConclusionEven though gliclazide and dapagliflozin have different metabolic actions in patients with T2D, neither treatment altered the faecal microbiome, thereby suggesting that the observed metabolic changes are not mediated by their effects on the microbiota.     

芪连温胆汤联合二甲双胍、格列齐特治疗消渴病对照观察

[目的]观察芪连温胆汤联合二甲双胍、格列齐特治疗消渴病疗效。[方法]使用对照观察方法,将90例门诊患者按就诊顺序编号方法随机分为两组,对照组45例①二甲双胍片,0．25g／次,2次／d;②格列齐特缓释片,30mg/次,1次／d。治疗组45例芪连温胆汤（黄芪12g,黄连、半夏、竹茹各9g,枳实6g,茯苓、陈皮各9g,生姜3g,炙甘草6g;口渴明显加花粉、麦冬各9g;头晕胸闷舌质暗加丹、山楂各9g;大便溏泄加白术、党参、山药各9g;烦躁失眠不安加郁金、白芍各9g,酸枣仁12g;尿多而混浊加山萸肉、益智仁各10g）1剂／d,水煎200mL,早晚口服。西药治疗同对照组。连续治疗30d为1疗程。观测临床症状、空腹血糖（FBG）、餐后2h血糖（2hPG）、糖化血红蛋白（HbAle）、不良反应。连续治疗2疗程,判定疗效。[结果]治疗组显效30例,有效12例,无效3例,总有效率93．30％。对照组显效24例,有效11例,无效10例,总有效率77．80％。治疗组疗效优于对照组。FBG、2hPG、HbAlc治疗组改善优于对照组。[结论]芪连温胆汤联合二甲双胍、格列齐特治疗消渴病,疗效满意,无副作用,值得推广。     

RP-HPLC法测定格列齐特片（Ⅱ）的有关物质及含量

目的建立RP-HPLC法测定格列齐特片（Ⅱ）的有关物质及含量。方法采用反相高效液相色谱法,固定相为辛烷基硅烷键合硅胶（150×4．6mm,5μm）,流动相为水-乙腈-三乙胺-三氟乙酸（60：40：0．1：0．1）,流速1．0ml／min,检测波长为235nm。结果格列齐特在0．01-1．00mg／ml浓度范围内与峰面积呈良好线性关系（r=0．9999）,检测限为0．1μg/ml。平均回收率分别为101．2％（n=9）。结论该方法专属性好、准确、灵敏,用于格列齐特片（Ⅱ）的含量及有关物质测定结果可靠。     

格列吡嗪与格列齐特合治2型糖尿病的观察

目的：观察格列吡嗪与格列齐特合用是否可以更有效地控制2型糖尿病患者的血糖。方法：取63名患者，根据其一天中血糖变化分别服用格列吡嗪及格列齐特，监测血糖随时调整药量，4个月后将其各时段血糖及HbAlc与治疗前所检测结果进行统计学处理。结果：合用格列吡嗪与格列齐特4个月后各时段血糖及HbAlc控制基本达标，比治疗前的血糖及HbAlc有显著好转。结论：利用格列吡嗪与格列齐特作用时间和半衰期的不同，根据血糖波动情况分别服用，可达到良好控制血糖的目的。     

分析2型糖尿病患者应用达美康缓释片联合二甲双胍的临床疗效及其对生活质量的影响

目的评判2型糖尿病患者接受达美康缓释片+二甲双胍的临床价值。方法选取该院在2016年6月—2019年12月的130例2型糖尿病患者,根据患者的入院编号状况分组分为甲组入院编号单数65例,乙组入院编号双数65例。甲组采用达美康缓释片+二甲双胍方案,乙组采用二甲双胍单药方案,比较两组的临床疗效。结果甲组的治疗总有效率高于乙组,两组对比差异有统计学意义(P<0.05);治疗前两组空腹血糖、餐后2 h血糖、糖化血红蛋白比较,差异无统计学意义(P>0.05)。治疗后,甲组、乙组上述血糖指标比较,差异有统计学意义(P<0.05);两组生活质量评分相比,差异有统计学意义(P<0.05)。结论2型糖尿病患者治疗中应用达美康缓释片、二甲双胍联合方案,不但治疗效果理想,而且可有效改善患者的生活质量、血糖状况。     

格列齐特对2型糖尿病GK大鼠离体心肌缺血预适应的影响

目的 研究格列齐特对糖尿病GK大鼠离体心脏缺血预适应(ischemic preconditioning, IPC)保护作用的影响。方法 采用GK大鼠离体心脏Langendorff灌流模型,分为Wistar大鼠缺血预处理对照组(CON组)、GK大鼠缺血预适应保护组(GK组)、缺血预适应+格列齐特组(10μmol/L)(IPC+Glc组),每组8只。记录各组血流动力学指标,灌流后检测心肌梗死面积。结果 灌流30min时,与CON组相比,IPC+Glc组左心室功能有一定程度的改善(P＜0.05),IPC+Glc组和GK组心肌梗死面积无明显变化(P＞0.05)。结论 格列齐特未影响缺血预适应对心肌的保护作用。     

瑞格列奈与格列齐特治疗2型糖尿病的效果比较

目的：探讨瑞格列奈与格列齐特治疗2型糖尿病的临床效果。方法选取2012年5月~2013年6月本院收治的2型糖尿病患者146例,随机分为两组,分别给予瑞格列奈与格列齐特进行治疗,通过测定患者的BMI、FPG、HbA1c、2 h PG等指标,比较两组的疗效。结果两组治疗前的BMI、FPG、HbA1c、2 h PG水平比较,差异无统计学意义（P〉0.05）,两组治疗后的BMI、FPG、HbA1c、2 h PG水平较治疗前显著下降,差异有统计学意义（P〈0.05）,瑞格列奈组治疗后的BMI、FPG、HbA1c水平显著低于格列齐特组,差异有统计学意义（P〈0.05）,两组治疗后的2 h PG水平比较,差异无统计学意义（P〉0.05）;瑞格列奈组的总有效率为91.8%,高于格列齐特组的84.9%,差异有统计学意义（P〈0.05）。结论瑞格列奈治疗2型糖尿病的效果优于格列齐特。