那格列奈对初诊2型糖尿病患者胰岛素分泌及动态血糖的影响

目的 观察不同血糖水平的初诊2型糖尿病患者服用那格列奈后胰岛素分泌及动态血糖变化,为临床决策提供依据.方法 入选2007年7月至2009年6月在佛山中医院内分泌科就诊的初诊2型糖尿病患者36例,男18例,女18例,年龄(44±3)岁.根据空腹血糖水平分为A组(空腹血糖5.0～6.9 mmol/L)、B组(空腹血糖7.0～8.9 mmo/L)、C组(空腹血糖9.0～11.1 mmol/L),每组各12例.行口服葡萄糖耐量-胰岛素释放试验后3 d内开始持续血糖监测,24 h后行那格列奈-口服葡萄糖耐量-胰岛素释放试验(NAT-OGTF-IRT),NAT-OGTY-IRT及之后每餐前10 min 口服那格列奈120 mg.监测服用那格列奈前后胰岛素分泌及动态血糖变化.计算糖负荷后30 min胰岛素和葡萄糖增加的比值(ΔI30/ΔG30)、24 h血糖波动幅度、24 h血糖达标时间.组内治疗前后计量资料比较采用配对t检验,组间比较采用方差分析.结果 口服那格列奈后,与C组相比,A组、B组糖负荷后ΔI30/ΔG30的增量显著增加分别为(9.6±2.1)、(5.2±1.7)vs(0.6±0.4)U/mol,F=7.431,P<0.01].与持续血糖监测第1天比较,服用那格列奈第3天A组、B组、C组24h血糖波动幅度均明显下降分别为(4.9±1.5)mmol/L vs(10.5±2.1)mmol/L、(4.9±1.6)mmol/L vs(10.2±1.9)mmol/L、(8.6±1.6)mmol/L vs(10.4±2.2)mmol/L,t值分别为10.827、10.307、5.377,P<0.01];与C组比较,A组、B组血糖波动幅度下降更为明显(F=24.950,P<0.01).A组、B组患者24 h血糖达标时间显著延长分别为(16.5±1.2)h vs(21.3±0.4)h、(11.3±1.6)h vs(17.7±1.2)h,t值分别为-12.782、-11.296,P<0.01],C组无显著变化.结论 那格列奈通过促进早期胰岛素分泌显著减少初诊2型糖尿病患者血糖波动,延长血糖达标时间,该药对空腹血糖相对较低的2型糖尿病患者更为有效.

Effects of nateglinide on insulin secretion and dynamic glucose change in newly diagnosed type 2 diabetic patients

Objective To observe the effects of nateglinide treatment on insulin secretion and dynamic glucose change in newly diagnosed type 2 diabetic patients.Methods A total of 36 newly diagnosed type 2 diabetic patients were enrolled in this study.According to the levels of fasting plasma glucose(FPG),all the subjects were divided into group A(FPG 5.0-6.9 mmol/L;n=12),group B (FPG 7.0-8.9 mmol/L;n=12),and group C(FPG 9.0-11.1 mmol/L;n=12).All the subjects underwent continue glucose monitor(CGM)for 72 hours within 3 days after the oral glucose toleranceinsulin release test(OGTT-IRT).After 24 hours of CGM, the participants underwent the nateglinide-oral glucose tolerance-insulin release test(NAT-OGTT-IRT),and received single 10-minute preprandial nateglinide(120 mg)during the test and after that.Data in the same group before and after the intervention were compared by matched pair t test,while one-way ANOVA was used for the comparison between groups.Results Compared with the group C.the increase of the ratio of insulin increase and glucose increase 30 minutes after glucose load(ΔI30/ΔG30)was significantly raised in the group A and group B((9.6±2.1),(5.2±1.7),and(0.6±0.4)U/mol,respectively;F=7.431,P<0.01).Compared with that in the first day of CGM, the amplitude of glycemic excursions(AGE)of the three groups showed a significant decrease in the third day((4.9±1.5)mmol/L vs(10.5±2.1)mmol/L,(4.9±1.6)mmol/L vs (10.2±1.9)mmol/L,(8.6±1.6)mmol/L vs(10.4±2.2)mmol/L,respectively;P<0.01).The AGE was decreased more significantly in the group A and group B compared with the group C(F=24.950,P<0.01).Compared with that in the first day,there were a longer duration when plasma glucose achieved the target level after taking nateglinide in the third day of CGM in the group A and group B((16.5±1.2)h vs(21.3±0.4)h,(11.3±1.6)h vs(17.7±1.2)h,respectively;t values were-12.782 or -11.296,P<0.01).However,no significant difference was found in the group C.Conclusions Nateglinide Can stimulate insulin release,decrease glycemic fluctuation and prolong the duration that plasma glucose achieves the target level in the newly diagnosed type 2 diabetic patients.Moreover,nateglinide may exert more effective role in type 2 diabetic patients with lower FPG levels.