短期胰岛素强化与沙格列汀联合二甲双胍治疗新诊断的2型糖尿病的疗效比较

目的:比较短期胰岛素强化与沙格列汀联合二甲双胍治疗新诊断的2型糖尿病病人的临床效果。方法:选取新诊断的2型糖尿病病人102例，按照随机数字法分为短期胰岛素强化治疗组（短期组）和沙格列汀联合二甲双胍治疗组（联合组），各51例。分别于治疗前和治疗12周后，抽取2组病人空腹静脉血，检测病人空腹血糖（FPG）、餐后2 h血糖（2hPG）、糖化血红蛋白（HbA1c）、空腹C肽（FC-P）、餐后2 h C肽（2hC-P）、脂联素（ADP）及胰高血糖素化（GC）水平，并计算病人稳态模型胰岛素分泌指数（HOMA-β）和稳态模型胰岛素抵抗指数（HOMA-IR），记录血糖达标时间和低血糖发生情况。结果:治疗后2组FPG、2hPG、HbA1c均较治疗前明显降低（P<0.01），短期组HbA1c明显低于联合组（P<0.01），而2组间FPG、2hPG差异均无统计学意义（P>0.05）。治疗后2组FC-P、2hC-P、HOMA-β、HOMA-IR均较治疗前改善（P<0.05），而2组间FC-P、2hC-P、HOMA-β、HOMA-IR差异均无统计学意义（P>0.05）。联合组治疗后GC水平和体质量指数均明显低于治疗前（P<0.01），而短期组治疗前后GC、体质量指数差异均无统计学意义（P>0.05）。治疗后2组ADP水平均较治疗前明显上升（P<0.01），但联合组上升更为明显（P<0.01）。2组血糖达标时间差异无统计学意义（P>0.05）；短期组低血糖发生率明显高于联合组（P<0.01）。结论:短期胰岛素强化与沙格列汀联合二甲双胍均可控制新诊断的2型糖尿病病人血糖，改善胰岛β细胞功能，其中短期胰岛素强化在降低HbA1c水平方面更具优势，而沙格列汀联合二甲双胍可明显抑制GC水平，增加ADP水平，且不增加体质量，低血糖发生率低。

Clinical effect comparison between the short-term intensive insulin and metformin combined with saxagliptin in the treatment of early type 2 diabetes

Objective: To compare the clinical effects between the short-term intensive insulin and metformin combined with saxagliptin in the treatment of early type 2 diabetes.Methods: One hundred and two early type 2 diabetes patients were randomly divided into the short-term intensive insulin therapy group(short-term group) and saxagliptin combined with metformin therapy group(combination group) according to the random number table method(51 cases each group).Before treatment and after 12 weeks of treatment,the levels of fasting plasma glucose(FPG),2 h postprandial glucose(2hPG),glycosylated hemoglobin(HbA1c),fasting C-peptide(FC-P),postprandial 2 h C peptide (2hC-P),fat adiponectin(ADP) and glucagon(GC) in two groups were detected,the homeostasis model insulin secretion index(HOMA-β) and insulin resistance index(HOMA-IR) in two groups were calculated,and the blood glucose standard time and hypoglycemia incidence in two groups were recorded.Results: After treatment,the levels of FPG,2hPG and HbA1c in two groups significantly decreased compared with before treatment(P<0.01),the level of HbA1c in short-term group was significantly lower than that in combination group(P<0.01),and the differences of the levels of FPG and 2hPG between two groups were not statistically significant(P>0.05).After treatment,the FC-P,2hC-P,HOMA-β and HOMA-IR in two groups were significantly improved compared with before treatment(P<0.05),and the differences of the levels of FC-P,2hC-P,HOMA-β and HOMA-IR between two groups were not statistically significant(P>0.05).The levels of GC and body mass index in combination group after treatment were significantly lower than those before treatment(P<0.01),and the differences of the levels of GC and body mass index in short-term group between before and after treatment were not statistically significant(P>0.05).After treatment,the levels of ADP in two groups significantly increased compared with before treatment(P<0.01),which in combination group was more significant than that in short-term group(P<0.01).The difference of blood glucose standard time between two groups was not statistically significant(P>0.05),and the incidence rate of hypoglycemia in short-term group was significantly higher than that in combination group(P<0.01).Conclusions: The short-term intensive insulin and saxagliptin combined with metformin in treating the early type 2 diabetes can control the level of blood glucose and improve the islet β-cell function of patients.The short-term intensive insulin can obviously reduce the HbA1c level,and the saxagliptin combined with metformin can significantly inhibit the GC level,increase the ADP level,decrease the incidence rate of hypoglycemia,and does not affect the body weight of patients.