外源性胰岛素在老年2型糖尿病患者骨质疏松治疗中的作用

目的观察2型糖尿病患者骨质疏松患者治疗中,外源性胰岛素和口服降糖药物治疗对骨代谢、骨密度的不同影响。方法收集2013年8月至2015年8月在本院就诊的2型糖尿病合并骨质疏松患者98例,随机分为2组。A组阿仑膦酸钠、维D_3片联合胰岛素(诺和灵30R)治疗组,B组阿仑膦酸钠、维D_3片联合口服降糖药物(亚莫利)组。记录两组患者治疗前后第12周、24周、52周的空腹血糖(FPG)、糖化血糖蛋白(HbAlC)、体重指数(BMI)、碱性磷酸酶(AKP)、N端骨钙素(N-MID)、25(OH)D_2+D_3、血钙(Ca)及骨密度(BMD),并分析治疗后两组结果的差异。结果两组患者治疗第后12周FPG及Hb Alc较治疗前均显著下降(P0.05)。治疗后第24周,两组患者25(OH)D_2+D_3、体重指数(BMI)及骨密度(BMD)较治疗前显著增加(P0.05),A组较B组更明显(P0.05)。治疗后第52周,A组患者体重指数(BMI)、血钙(Ca)、25(OH)D_2+D_3、骨密度(BMD)较治疗前显著增加(P0.05),B组患者25(OH)D_2+D_3、血钙及骨密度(BMD)较治疗前显著增加(P0.05),A组患者体重指数(BMI)及骨密度(BMD)较B组显著增加(P0.05)。结论外源性胰岛素治疗较口服降糖药物在骨代谢、骨密度增高方面更有益。

Effect of exogenous insulin in the treatment of osteoporosis in elderly type 2 diabetes mellitus patients

Object To study the different effects of exogenous insulin and oral glucose-lowering drugs therapy on bone metabolism and bone mineral density in type 2 diabetes patients with osteoporosis. Method 98 elderly type 2 diabetes mellitus with osteoporosis patients were selected and randomly divided into 2 groups. A group received Insulin + Alendronate sodium phosphate vitamin D3, and B group received Amaryl+ Alendronate sodium phosphate vitamin D3. BMI, AKP, N-MID, 25(OH)D2+D3, blood calcium and BMD were measured at baseline and after 12, 24 and 52 weeks of treatment. The changes after treatment within each group and between the two groups were compared. Results After 12-weeks of treatment, FPG and HbAlc in both groups decreased significantly (P < 0. 0.5). After 24-weeks of treatment, 25(OH)D2+D3, BMI and BMD in both groups increased significantly compared with that of baseline (P < 0. 05), and the increase was greater in group A than group B. After 52-weeks treatment, BMI, blood calcium, 25(OH)D2+D3 and BMD in A group increased significantly compared with that of baseline (P < 0. 05), and 25(OH)D2+D3, BMD and blood calcium in B group increased significantly compared with that of baseline (P < 0. 05). BMI and BMD in A group increased more significantly compared with that in B group (P < 0. 05). Conclusion Exogenous insulin therapy had more beneficial effects on bone metabolism and bone mineral density than oral hypoglycemic drugs.