那格列奈和瑞格列奈在2型糖尿病中对胰岛素的作用

目的:对比那格列奈、瑞格列奈合并二甲双胍用药治疗2型糖尿病12周后胰岛素快速分泌相和B细胞分泌胰岛素功能的改变.方法:61个经4周单用二甲双胍后病例随机分入那格列奈组和瑞格列奈组进行12周药物治疗.在0周和12周检测空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1C)、空腹胰岛素(FIN)及餐后1 h胰岛素(1 h IN)水平,并比较治疗前后胰岛素分泌相改变程度及HOMA-IR模型中B细胞功能指数(HOMA-IS)的变化.结果:(1)两组FPG、2 h PG及HbA1C均较治疗前有显著下降,P＜0.05,组间比较差异无显著性.(2)以1 h IN与空腹胰岛素FIN比值作为评估胰岛素分泌改变程度指标,两组12周其比值均高于治疗前,P＜0.05,但组间比较无差异;治疗后两组HOMA-IS显著高于治疗前,P＜0.05,治疗后两组之间无差异.(3)影响1 h IN /FIN及HOMA-IS的主要因素为糖尿病病史.结论:那格列奈和瑞格列奈与二甲双胍联合治疗2型糖尿病在降糖、促进胰岛素快速分泌和改善B细胞分泌功能均有显著作用.病史的长短是决定胰岛素快相分泌及胰岛B功能的重要因素.

The function of nateglinide and repaglinide on the insulin for the type Ⅱ diabets

OBJECTIVE To compare the effects of nateglinide plus metformin and repaglinide plus metformin on rapid phase of insulin secretion and B cell function in patients with type 2 diabetes.METHODS Enrolled patients ( n =61) with a 4 week metformin run in therapy period were randomized to addition of negalinide or repaglinide for 12 weeks.FPG,FIN and HbA 1C were assessed on fasting state as well as 2 h PG and 1 h IN were assessed after a standard meal at baseline and week 12.RESULTS (1)Final FPG,2 h PG and HbA 1C were significantly lower before than after treatment in both groups, P < 0.05 ,but no significant difference between them.(2)The ratio of 1 h IN and FIN for elevating the secretion of insulin in both groups before treatment is significant lower than after treatment, P < 0.05 ,but no difference of this ratio between these two groups after treatment. AS same as in HOMA IS, P < 0.05 .(3) The history of diabetes is the main factor of the changes of 1 h IN/FIN and HOMA IS.CONCLUSION The addition of nateglinide to metformin and repaglinide to metformin treatment resulted in reductions of FPG,2 h PG and HbA 1C,as well as the increasing of secretion of rapid phase insulin and the function of B cell.But there was no significant difference between netaglinide and repaglinide.The history of diabetes is the predictor of the function of B cell and rapid phase secretion of insulin.