甘精胰岛素联合格列美脲和阿卡波糖治疗磺脲类药物治疗失效的2型糖尿病的疗效观察

目的探讨甘精胰岛素注射液联合格列美脲片和阿卡波糖片治疗磺脲类药物治疗失效的2型糖尿病的临床疗效。方法选取2014年10月—2016年6月中山大学附属第三医院粤东医院内分泌科收治的磺脲类药物治疗失效的2型糖尿病患者136例,按照治疗方案的不同分为甘精胰岛素联合格列美脲组(44例)、甘精胰岛素联合阿卡波糖组(43例)、甘精胰岛素联合格列美脲和阿卡波糖组(49例)。甘精胰岛素联合格列美脲组每日晚餐后皮下注射甘精胰岛素注射液,起始剂量10 U/d;晚餐后30 min口服格列美脲片2 mg。甘精胰岛素联合阿卡波糖组每日晚餐后皮下注射甘精胰岛素注射液,起始剂量10 U/d;口服阿卡波糖片50 mg,3次/d;甘精胰岛素联合格列美脲和阿卡波糖组每日晚餐后皮下注射甘精胰岛素,起始剂量10 U/d;晚餐后30 min口服格列美脲片2 mg;口服阿卡波糖片50 mg,3次/d。治疗3个月后比较各观察指标。结果治疗后,3组空腹血糖(FBG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)水平均降低(P0.05),且甘精胰岛素联合格列美脲和阿卡波糖组血糖指标改善优于甘精胰岛素联合格列美脲组、甘精胰岛素联合阿卡波糖组(P0.05)。治疗后,3组稳态模型评估胰岛素抵抗指数(HOMA-IR)降低,胰岛β细胞功能指数(HOMA-β)、餐后2 h胰岛素、餐后2 h C-肽均升高(P0.05),且甘精胰岛素联合格列美脲和阿卡波糖组胰岛功能改善优于甘精胰岛素联合格列美脲组、甘精胰岛素联合阿卡波糖组(P0.05)。甘精胰岛素联合格列美脲和阿卡波糖组血糖达标时间短于甘精胰岛素联合格列美脲组、甘精胰岛素联合阿卡波糖组(P0.05),胰岛素日用量低于甘精胰岛素联合格列美脲组、甘精胰岛素联合阿卡波糖组(P0.05),低血糖发生率低于甘精胰岛素联合格列美脲组(P0.05),而与甘精胰岛素联合阿卡波糖组差异无统计学意义。结论甘精胰岛素注射液联合格列美脲片和阿卡波糖片治疗磺脲类药物治疗失效的2型糖尿病可有效控制血糖水平,缩短血糖达标时间,且不增加低血糖发生率,具有一定的临床推广应用价值。

Clinical observation of insulin glargine combined with glimepiride and acarbose in treatment of type 2 diabetes with sulfonylurea treatment failure

Objective To explore the clinical curative effect of Insulin Glargine Injection combined with Glimepiride Tablets and Acarbose Tablets in treatment of type 2 diabetes with sulfonylurea treatment failure.Methods Patients (136 cases) with type 2 diabetes with sulfonylurea treatment failure in Department of Endocrine of The Third Affiliated Hospital, Sun Yat-Sen University, Yuedong Hospital from June 2014 to June 2016 were divided into insulin glargine combined with glimepiride (44 cases), glargine combined with acarbose (44 cases), and insulin glargine combined with glimepiride and acarbose (49 cases) groups based on different treatments. The patients in the insulin glargine combined with glimepiride group were sc administered with Insulin Glargine Injection with initial dosage of 10 U/d after supper, and were also po administered with Glimepiride Tablets 2 mg at 30 min after supper. The patients in the insulin glargine combined with acarbose group were sc administered with Insulin Glargine Injection with initial dosage of 10 U/d after supper, and were also po administered with Acarbose Tablets 50 mg, three times daily. The patients in the insulin glargine combined with glimepiride and acarbose group were sc administered with Insulin Glargine Injection with initial dosage of 10 U/d after supper, were po administered with Glimepiride Tablets 2 mg at 30 min after supper, and were also po administered with Acarbose Tablets 50 mg, three times daily. After treatment for three months, the clinical indexes in three groups were observed. Results After treatment, levels of FBG, 2hPG, and HbA1c in three groups were significantly decreased (P < 0.05), and the blood glucose indexes in the insulin glargine combined with glimepiride and acarbose group were significantly better than those in the insulin glargine combined with glimepiride and insulin glargine combined with acarbose group (P<0.05). After treatment, HOMA-IR in three groups were significantly decreased, but HOMA-β, postprandial 2 h insulin, and postprandial 2 h C- peptide were significantly increased (P < 0.05), and the islet function indexes in the insulin glargine combined with glimepiride and acarbose group were significantly better than those in the insulin glargine combined with glimepiride and insulin glargine combined with acarbose group (P<0.05). Blood sugar up to the standard times in the insulin glargine combined with glimepiride and acarbose group were shorter than those in the insulin glargine combined with glimepiride and insulin glargine combined with acarbose group (P<0.05). The daily doses of insulin in the insulin glargine combined with glimepiride and acarbose group were lower than those in the insulin glargine combined with glimepiride and insulin glargine combined with acarbose group (P<0.05). The incidences of hypoglycemia in the insulin glargine combined with glimepiride and acarbose group were lower than those in the insulin glargine combined with glimepiride group (P<0.05), but there was no significant difference with those in the insulin glargine combined with acarbose group. Conclusion Insulin Glargine Injection combined with Glimepiride Tablets and Acarbose Tablets can effectively control the blood glucose level, shorten the time of blood glucose, and do not increase incidence of hypoglycemia in the treatment of type 2 diabetes with sulfonylurea treatment failure, which has a certain clinical application value.