果糖注射液对糖尿病患者血糖及胰岛素的影响

目的评价果糖注射液对糖尿病患者血糖、胰岛素和血尿酸的影响。方法69例2型糖尿病（T2DM）病人随机分为果糖注射液组（35例）和生理盐水组（34例），每日分别给予500ml 5％果糖注射液或生理盐水，3小时输入。于输液第0h、1．5h、3h测定静脉血糖和胰岛素水平；0h和3h测血尿酸水平。结果两组输液过程中各输液时点的血糖、胰岛素及尿酸的差异均无统计学意义。结论与生理盐水比较，果糖注射液对T2DM患者血糖、胰岛素及血尿酸水平均无明显影响。     

New Developments in Diabetes Management: Medications of the 21st Century

Background

Suboptimal blood glucose control among patients with type 2 diabetes continues to support the need for new pharmacologic approaches.

Objective

The purpose of this commentary was to highlight newly available and soon-to-be available agents that are promising tools for targeting specific pathophysiologic pathways in the management of diabetes.

Methods

Published evidence to support the application of novel incretin-based therapies, dipeptidyl peptidase (DPP)-4 inhibitors, sodium-glucose cotransporter (SGLT)-2 inhibitors, other oral agents and insulins for managing specific aspects of type 2 diabetes, as well as disadvantages associated with those novel medications, are discussed.

Results

Several new glucagon-like peptide (GLP)-1 receptor agonists with different time frames of action, although each has unique advantages and disadvantages, have been through clinical trials. Examples of these are lixisenatide and albiglutide. Currently available DPP-4 inhibitor agents, important for inhibiting the breakdown of endogenous GLP-1, have not been associated with weight gain or hypoglycemia. SGLT-2 inhibitors, which do not depend on insulin secretion or insulin action, may be advantageous in that they appear to be broadly efficacious at all stages of diabetes. New insulin analogues, such as degludec and U-500, improve glycemic control without contributing to hypoglycemia.

Conclusions

Advances in pharmacologic options offer the promise of improving glycemic control for longer periods, with limited glycemic fluctuations, hypoglycemia, and weight gain. However, the effectiveness of these agents ultimately depends on their availability to providers managing the health care of patients at high risk for poor diabetes outcomes and patients’ use of them as directed. Long-term effectiveness and safety trials are ongoing.     

Understanding how pharmacokinetic and pharmacodynamic differences of basal analog insulins influence clinical practice

This article reviews pharmacokinetic (PK) and pharmacodynamic (PD) concepts relating to the pharmacology of basal insulin analogs. Understanding the pharmacology of currently available long-acting basal insulins and the techniques used to assess PK and PD parameters (e.g. the euglycemic clamp method) is important when considering the efficacy and safety of these agents, and can help in understanding the rationale for specific dosing strategies when tailoring therapy for a specific patient. Basal insulins such as insulin glargine 100 units (U)/mL and insulin detemir show improved PK/PD characteristics compared with the intermediate-acting NPH insulin, with a longer duration of action, a more consistent glucose-lowering effect and less prominent concentration peaks. However, more recently developed basal insulins (insulin glargine 300?U/mL, and insulin degludec 100?U/mL and 200?U/mL) have PK/PD profiles closer to the physiologic profile of endogenous basal insulin owing to a more evenly distributed, predictable and prolonged time–action profile that exceeds 24?hours and improved within-patient variability in glucose-lowering effect. The clinical implications and relevance of these PK/PD profiles is explored, including the potential effect of PK/PD parameters on glycemic control and hypoglycemia, and the timing of dosing. The improved PK/PD properties of newer longer-acting basal insulins may translate into clinical benefits for patients with type 1 and type 2 diabetes, such as more consistent insulin levels in the blood over 24?hours, lower intra-patient variability, a reduced risk of nocturnal hypoglycemia, and more flexibility in dosing time, all of which are important to consider when choosing a basal insulin regimen.     

口服降糖药分别联合不同胰岛素类似物治疗血糖控制不佳2型糖尿病的临床研究

目的　比较二甲双胍分别联合地特胰岛素、双相门冬胰岛素30治疗单纯口服降糖药血糖控制不佳2型糖尿病（T2DM）的临床疗效与安全性。方法　选取2014年8月—2016年12月无锡市第二人民医院收治的单纯口服降糖药血糖控制不佳T2DM患者112例为研究对象,采用随机数字表将患者分为A组57例、B组55例。所有患者停服除二甲双胍外所有降糖药,A组采用二甲双胍+地特胰岛素降糖方案,B组采用二甲双胍+双相门冬胰岛素30降糖方案,治疗12周后比较两组血糖指标、胰岛功能指标及药物不良反应。结果　治疗期间,A、B组分别脱失2例、1例。治疗12周后,两组患者空腹血糖（FPG）、餐后2 h血糖（2 hPG）、糖化血红蛋白（HbA1c）比较,差异均无统计学意义（P>0.05）;A组和B组治疗12周后FPG、2 hPG、HbA1c较治疗前降低（P<0.05）。治疗12周后,两组患者FPG、2 hPG、HbA1c达标率比较,差异均无统计学意义（P>0.05）。治疗12周后,两组患者稳态模型胰岛β细胞功能指数（HOMA-β）、稳态模型胰岛素抵抗指数（HOMA-IR）比较,差异均无统计学意义（P>0.05）。A组和B组治疗12周后HOMA-β较治疗前升高,HOMA-IR较治疗前降低（P<0.05）。A组患者胰岛素类似物用量为（24.96±3.57）U/d,B组患者胰岛素类似物用量为（25.18±3.85）U/d,差异无统计学意义（t=0.309,P=0.758）。治疗前及治疗12周后,两组患者体质指数（BMI）比较,差异均无统计学意义（P>0.05）;两组患者治疗前与治疗12周后BMI比较,差异均无统计学意义（P>0.05）。治疗期间两组患者低血糖事件、转氨酶升高、头痛、胃肠功能紊乱发生率比较,差异均无统计学意义（P>0.05）。结论　对单纯口服降糖药血糖控制不佳的T2DM患者,采用二甲双胍联合地特胰岛素或双相门冬胰岛素30均能在无明显体质量变化的基础上达到相似的降糖效果。