艾塞那肽与甘精胰岛素治疗血糖控制不佳的2型糖尿病的临床对照研究

目的探讨艾塞那肽与甘精胰岛素治疗血糖控制不佳的2型糖尿病(T2DM)的临床疗效、用药依从性以及安全性。方法选择我院收治的血糖控制不佳的2型糖尿病患者为研究对象,随机分为艾塞那肽组和甘精胰岛素组,在原有口服降糖药物治疗基础上,分别给予艾塞那肽和甘精胰岛素皮下注射以控制血糖,观察并记录两组患者治疗前后的血糖控制情况、糖化血红蛋白(HbA1c)变化、体重变化情况,同时对两组患者用药的依从性及用药期间的不良反应发生情况进行对比分析。结果治疗26周后,两组患者临床症状及血糖均较治疗前有明显改善,甘精胰岛素组显效率略高于艾塞那肽组,但差异无统计学意义(P>0.05)。两组患者FBG、2hPG、HbA1c水平均较治疗前有明显改善(P<0.05或P<0.01);甘精胰岛素组FBG水平较艾塞那肽组改善更为明显(P<0.05);艾塞那肽组2hPG、HbA1c水平较甘精胰岛素组改善更为显著(P<0.05);艾塞那肽组HbA1c<7%的达标率明显高于甘精胰岛素组(P<0.05),而HbA1c<6.5%的达标率高于甘精胰岛素组,但差异无统计学意义(P>0.05)。艾塞那肽组患者体重呈进行性降低,甘精胰岛素组患者体重呈进行性增加,但与治疗前比较差异均无统计学意义(P>0.05)。艾塞那肽组患者低血糖发生率低于甘精胰岛素组,恶心、腹泻发生率均高于甘精胰岛素组,但差异均无统计学意义(P>0.05)。艾塞那肽组患者用药依从性明显优于甘精胰岛素组,差异有统计学意义(P<0.05)。结论艾塞那肽与甘精胰岛素均能有效控制2型糖尿病患者血糖,降低糖化血红蛋白水平。虽然治疗期间艾塞那肽恶心、腹泻发生率较高,但往往症状较轻,低血糖发生率较低,能在一定程度上减轻体重压力,且能更好地降低HbA1c水平,同时具有良好的用药依从性,值得临床推广应用,但艾塞那肽的远期疗效仍需进一步研究证实。

Controlled clinical research of poor glycemic control in type 2 diabetes treating with exenatide and insulin glargine

Objective To investigate the clinical curative effect,medication compliance and safety of poor glycemic control in type 2 diabetes treating with exenatide and insulin glargine. Methods Poor glycemic control patients in our hospital were chose and randomly divided into exenatide group and insulin glargine group,on the basis of the original oral hypoglycemic drugs treating,respectively gave exenatide and insulin glargine injection to control blood sugar,observed and recorded the blood sugar,glycosylated hemoglobin（HbA1c）,body weight changes of the two groups before and after treatment,and contrastively analysed the medication adherence and the adverse reactions during the treatment. Results After 26 weeks treatment,the clinical symptoms and blood sugar of the two groups significantly improved than before treatment,the significant efficiency of insulin glargine group was slightly higher than exenatide group,but there was no significant difference（ P ＆gt; 0. 05）. FBG,2hPG,HbA1c levels of both groups significantly improved than before treatment（P ＆lt; 0. 05 or P ＆lt; 0. 05）;FBG level of insulin glargine group improved more significantly than exenatide group（ P ＆lt; 0. 05）;2hPG,HbA1c levels of exenatide group improved more significantly than insulin glargine group（P ＆lt; 0. 05）;HbA1c ＆lt; 7% control rate of exenatide group was significantly higher than insulin glargine group（P ＆lt; 0. 05）,and HbA1c ＆lt; 6. 5% control rate of exenatide group was higher than insulin glargine group,but there was no significant difference（P ＆gt; 0. 05）. The weight of exenatide group decreased,the weight of insulin glargine increased,but compared with before treatment,the differences had no significance（ P ＆gt; 0. 05）. The hypoglycemia incidence of exenatide group significantly lowered than insulin glargine group（P ＆lt; 0. 05）,nausea,diarrhea incidence were higher than insulin glargine group,but the differences had no significance（ P ＆gt; 0. 05）. The medication compliance of ex