甘精胰岛素联合瑞格列奈治疗老年2型糖尿病的疗效观察

目的观察老年2型糖尿病(T2DM)病人甘精胰岛素联合瑞格列奈降糖治疗的效果。方法 60例T2DM患者随机分为甘精组和预混组,甘精组三餐前15 min口服瑞格列奈0.5～1.0 mg,晚10∶00皮下注射甘精胰岛素。预混组于早晚饭前30 min注射预混胰岛素,应用罗康全血糖仪,住院期间监测空腹、三餐后2 h、夜10∶00、夜3∶00指尖血糖,根据血糖调整胰岛素剂量。空腹血糖(FPG)<7.0 mmol/L,餐后2 h血糖(2 hPG)<10.0 mmol/L为达标。观察血糖达标时间、胰岛素用量、低血糖发生次数、发生人数;12周后的FPG、2 hPG、糖化血红蛋白(HbAlc)、体质量指数(BMI)。结果两组血糖控制均达标,预混组和甘精组12周后,FPG2、hPG、HbA1c组间差异无统计学意义(P>0.05),组内与治疗前相比差异有统计学意义(P<0.01)。两组血糖达标时间差异无统计学意义(P>0.05),甘精组BMI较治疗前无明显增加(P>0.05),预混组BMI较治疗前明显增加(P<0.05)。甘精组胰岛素日用量、低血糖发生人数显著低于预混组(P<0.01),差异有统计学意义。结论两种治疗方案对控制血糖都有效,但甘精胰岛素联合瑞格列奈降糖治疗方案能减少注射次数和胰岛素的日用量,减少低血糖风险,不增加体质指数,依从性好。     

Comparison of glycaemic control and cardiovascular risk profile in patients with type 2 diabetes during treatment with either repaglinide or metformin

Objective: To compare glycaemic control and cardiovascular risk profile in patients with type 2 diabetes following 12 months’ treatment with either repaglinide or metformin. Study design and methods: This was an open uncontrolled randomised study in n=112 patients with inadequately controlled type 2 diabetes not previously treated with oral hypoglycaemic agents. Patients beginning treatment with either repaglinide or metformin entered an 8-week titration period (to optimise dosage: repaglinide, 2–4 mg/day; metformin, 1500–2500 mg/day) followed by a 12-month treatment period. Glycaemic control and cardiovascular risk factors were determined at baseline and at the end of the treatment period. Results: Mean (S.D.) final drug doses were 3 (±1) mg/day in the repaglinide group and 2000 (±500) mg/day in the metformin group. Significant improvements in glycaemic control [glycated haemoglobin, fasting and 2-h postprandial plasma glucose (PPG)] were demonstrated in both treatment groups. The decrease in PPG was significantly greater in the repaglinide group (P<0.05). During the treatment period, fasting plasma insulin (FPI) decreased significantly in both groups, more so with metformin (P<0.05). Two-hour postprandial plasma insulin (PPI) levels decreased only in the metformin group (P<0.05). Significant improvements between baseline and final visit were demonstrated in one or both groups in the following cardiovascular risk factors: total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides, plasminogen activator inhibitor, lipoprotein(a) and homocysteine. No changes were observed in high-density lipoprotein cholesterol (HDL-C), apolipoprotein A-I, apolipoprotein B, fibrinogen, body mass index (BMI) or blood pressure. Conclusions: The use of repaglinide or metformin in drug therapy-naïve patients with type 2 diabetes over a 12-month period is associated with improvements in both glycaemic control and cardiovascular risk profile. The latter cannot necessarily be attributed to the pharmacotherapy per se, but provides reassurance in the context of initiating oral hypoglycaemic drug therapy with these agents.     

动态监测甘精胰岛素与预混胰岛素治疗期间老年2型糖尿病患者血糖漂移和低血糖发生率

用动态血糖监测的方法比较甘精胰岛素联合口服瑞格列奈,与每日注射2次预混胰岛素(诺和灵30R)治疗的老年2型糖尿病患者血糖漂移水平和低血糖发生情况.发现甘精组血糖漂移度明显低于预混组;低血糖事件也明显少于预混组.因此,老年2型糖尿病患者每天1次甘精胰岛素加瑞格列奈口服,在血糖达到良好控制时,血糖的漂移程度更低,低血糖发生率低.     

瑞格列奈与甘精胰岛素联合治疗新诊断2型糖尿病的疗效观察

目的：比较新诊断2型糖尿病患者应用胰岛素促泌剂瑞格列奈单一治疗及联合长效胰岛素甘精胰岛素治疗12周后血糖水平的差异。方法纳入2012年1月~2013年1月北京军区总医院新诊断2型糖尿病患者48例,随机分为单药治疗组（n=24）及联合治疗组（n=24）,单药治疗组仅餐前口服瑞格列奈（初始计量0.5 mg）,联合治疗组除餐前服用瑞格列奈外,每晚8 pm皮下注射甘精胰岛素（初始计量6 u）。根据血糖水平调整用药剂量,治疗12周后观察两组空腹静脉血糖（FBG）水平、餐后2小时血糖（2 hPBG）水平、糖化血红蛋白（HbA1c）水平及血糖达标时间。结果与单药治疗组相比,联合治疗组FBG[（5.9±1.6）mmol/L vs.（6.8±1.5）mmol/L]、2 hPBG[（8.8±0.9）mmol/L vs.（9.2±0.8）mmol/L]、HBA1c[（7.4±0.5）% vs.（7.8±1.3）%]均更低,且血糖达标时间明显缩短[（6.1±1.3）d vs.（8.9±2.5）d]。结论胰岛素促泌剂与长效胰岛素联合治疗2型糖尿病初始治疗较单独应用胰岛素促泌剂效果更好,并能促使血糖尽快达标。     

盐酸二甲双胍与瑞格列奈联用治疗糖尿病的临床效果研究

目的探究盐酸二甲双胍与瑞格列奈联用对糖尿病的临床治疗效果,提高盐酸二甲双胍与瑞格列奈联用的医疗价值。方法2018年1月—2019年6月,将120例糖尿病患者随机划分成观察组和对照组,并对观察组糖尿病患者予以盐酸二甲双胍与瑞格列奈联用治疗,对对照组糖尿病患者予以普通治疗方式,之后结合多方面数据信息对比分析观察组和对照组糖尿病患者临床治疗效果。结果通过多方面对比分析,可以看出通过盐酸二甲双胍与瑞格列奈联用治疗的糖尿病临床治疗效果明显高于普通治疗方法的糖尿病临床治疗效果,观察组与对照组之间差异有统计学意义(P<0.05)。结论对糖尿病患者开展盐酸二甲双胍与瑞格列奈联用治疗,能够在减缓患者糖尿病恶化速率的条件下,提高相应疾病综合治疗效果,这对于我国医学行业良性发展也起到非常重要的作用。     

Rifampicin seems to act as both an inducer and an inhibitor of the metabolism of repaglinide

Objective To investigate if rifampicin is both an inducer and an inhibitor of repaglinide metabolism, it was determined whether the timing of rifampicin co-administration influences the pharmacokinetics of repaglinide.Methods Male volunteers (n=12) participated in a randomised, two-period, crossover trial evaluating the effect of multiple doses of 600 mg rifampicin once daily for 7 days on repaglinide metabolism. Subjects were, after baseline measurements of repaglinide pharmacokinetics, randomised to receive, on either day 7 or day 8 of the rifampicin administration period, a single dose of 4 mg repaglinide and vice versa in the following period.Results When repaglinide was given, together with the last rifampicin dose, on day 7, an almost 50% reduction of the median repaglinide area under the plasma concentration–time curve (AUC) was observed. Neither the peak plasma concentration (C_max), time to reach C_max (t_max) nor terminal half-life (t_1/2) was statistically significantly affected. When repaglinide was given on day 8, 24 h after the last rifampicin dose, an almost 80% reduction of the median repaglinide AUC was observed. The median C_max was now statistically significantly reduced from 35 ng/ml to 7.5 ng/ml. Neither t_max nor t_1/2 was significantly affected.Conclusion When rifampicin and repaglinide are administered concomitantly, rifampicin seems to act as both an inducer and an inhibitor of the metabolism of repaglinide. After discontinuing rifampicin administration, while the inductive effect on CYP3A4 and probably also CYP2C8 is still present, an even more marked reduction in the plasma concentration of repaglinide was observed. Our results suggest that concomitant administration of rifampicin and repaglinide may cause a clinically relevant decrease in the glucose-lowering effect of repaglinide, in particular when rifampicin treatment is discontinued or if the drugs are not administered simultaneously or within a few hours of each other.The work was carried out at Odense University Hospital and Clinical Pharmacology, University of Southern Denmark, Winsløwparken 19², 5000 Odense C, Denmark     

那格列奈与瑞格列奈治疗2型糖尿病疗效与安全性的Meta分析

目的:系统评价那格列奈与瑞格列奈治疗2型糖尿病的疗效和安全性。方法:计算机检索Pubmed、EMbase、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、维普数据库、万方数据库中那格列奈和瑞格列奈治疗2型糖尿病的随机对照试验(RCT)的相关文献,采用RevMan5.0软件进行统计分析。结果:共有23项RCT,合计2402例患者满足纳入标准。Meta分析结果显示,2组空腹血糖值(FBG)[MD=-0.31,95%CI(-0.70,0.08),P=0.12]、餐后2h血糖(2hPBG)下降差值[MD=-0.08,95%CI(-0.31,0.15),P=0.49]、不良反应发生率[OR=0.92,95%CI(0.68,1.24),P=0.57]比较差异均无统计学意义;糖化血红蛋白(HbA1c)下降差值比较差异有统计学意义,瑞格列奈组明显优于那格列奈组[MD=-0.14,95%CI(-0.26,-0.02),P=0.03]。但国内、外比较结论有差异。结论:那格列奈与瑞格列奈降低FBG和2hPBG疗效相当,瑞格列奈降低HbA1c疗效优于那格列奈,二者的不良反应发生率无统计学差异。国内、外结论有差异,提示二药治疗效果可能与人种差异有关。     

不同剂量瑞格列奈对2型糖尿病患者治疗效果的影响

目的：分析不同剂量瑞格列奈对2型糖尿病患者治疗效果的影响。方法资料随机选自2013年2月~2014年2月在本院确诊为2型糖尿病且接受瑞格列奈治疗患者96例,依据每日瑞格列奈服用剂量随机分成3组,每组32例,对照组剂量为1.0 mg/d,研究A组为1.5 mg/d,研究B组为2.0 mg/d,比较3组患者的血糖指标、临床疗效与不良反应发生情况。结果3组患者治疗后的FINS、HOMA-β与HOMA-IR水平、血糖达标时间比较,差异无统计学意义（P〉0.05）;研究B组的低血糖发生率（21.88%）高于对照组的0（P〈0.05）;对照组治疗后的FBG与2 h PG高于研究A、B组（P〈0.05）。结论2型糖尿病患者瑞格列奈每日服用最佳剂量为1.0 mg,能够有效控制血糖且降低低血糖发生风险。     

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。     

瑞格列奈分别联合氨氯地平、氯沙坦钾治疗T2DM合并原发性高血压的疗效分析

目的:分析研究瑞格列奈分别联合氨氯地平、氯沙坦钾治疗T2DM合并原发性高血压的疗效。方法:选取我院于2015年7月～2017年7月收治T2DM合并原发性高血压310例患者,按随机数表法分为A组和B组各155例,两组均采用常规胰岛素疗法,同时口服瑞格列奈片,A组加用苯磺酸氨氯地平片;B组加用氯沙坦钾片。观察两组的临床疗效、不良反应以及肾功能、心血管功能。结果:治疗后,两组总有效率、不良反应发生率均无显著差异(P>0.05);两组肾功能、心血管功能指标均明显改善(P<0.05),但A组的肾功能指标改善程度优于B组(P<0.05),B组的心血管功能指标改善程度优于A组(P<0.05)。结论:对T2DM合并原发性高血压,采取瑞格列奈联合氨氯地平或氯沙坦钾进行治疗的安全性和临床疗效相当,两种疗法相比,前者改善肾脏功能更显著,后者改善心血管功能更显著。