西格列汀和伏格列波糖分别联合实时动态胰岛素泵对新诊断2型糖尿病患者的疗效对比
Comparison of therapeutic effects between sitagliptin and voglibose both combined with sensor-augmented insulin pump in newly diagnosed type 2 diabetes
目的 比较新诊断2型糖尿病(T2DM)患者采用西格列汀和伏格列波糖分别联合实时动态胰岛素泵(SAP)方案的疗效.方法 选择2014年2月至2015年2月在大连医科大学附属第一医院内分泌科住院的56例新诊断T2DM患者,糖化血红蛋白(HbA1c)9%~11%.将患者随机分为两组,SAP治疗基础上分别加用西格列汀100 mg,1次/d(S组,28例)和伏格列波糖0.2 mg,3次/d(V组,28例),共9d.同时启用实时持续血糖监测,观察血糖波动参数.本研究通过大连医科大学附属第一医院伦理委员会批准(KY2014-08).结果 两组患者基线资料比较差异均无统计学意义(均P >0.05).治疗9d后V组及S组空腹血糖(FPG)[(6.4±1.1)比(11.4±3.0)mmol/L,P=0.008;(5.5±0.8)比(11.0 ±2.1)mmol/L,P<0.001]、平均血糖(MBG)[(7.5±0.8)比(12.0±1.1) mmol/L,P=0.045;(6.7±0.7)比(12.5±1.3) mmol/L,P=0.002]、平均血糖波动幅度(MAGE) (P =0.024、0.029)、血糖水平标准差(SDBG) (P=0.023、0.036)均较治疗前显著下降,稳态模型胰岛β细胞功能较治疗前显著升高(P =0.002、0.001).S组日间血糖平均绝对差(MODD)(P =0.027)、空腹血糖变异系数(CV-FPG)(P=0.033)、稳态模型胰岛素抵抗指数(HOMA-IR)较治疗前显著降低(P =0.039).V组餐后血糖波动幅度(PPGE)(三餐分别为P=0.003、0.026、0.011)及低血糖指数(LBGI)(P=0.025)较治疗前显著降低,血糖达峰时间(△t)延长(三餐分别为P=0.028、0.026、0.030).治疗后V组PPGE显著低于S组(三餐分别为P=0.041、0.032、0.036),S组FPG、MBG显著低于V组(P=0.041、0.039).结论 针对新诊断T2DM患者,西格列汀或伏格列波糖联合SAP方案短期均可改善血糖控制,降低血糖波动,保护胰岛功能.西格列汀对平均血糖及空腹血糖的控制优于伏格列波糖,伏格列波糖对餐后血糖波动的改善优于西格列汀.
更多Objective To compare the therapeutic effects between sitagliptin and voglibose both with sensor-augmented insulin pump (SAP) in newly diagnosed type 2 diabetes mellitus (T2DM).Methods Fifty-six newly diagnosed hospitalized T2DM patients in Department of Endocrinology of the First Affiliated Hospital of Dalian Medical University,with hemoglobin A1c (HbA1c) value of 9%-11%,were randomized into the sitagliptin (S) group (n =28) and the voglibose (V) group (n =28) by block randomisation.Participants in S group received sitagliptin 100 mg per day,and V group received voglibose 0.2 mg for 3 times per day.All patients were treated with SAP for 9 days.Real-time continuous glucose monitoring (RT-CGM) was used.Glucose variability parameters were observed.The research has been approved by the ethics committee of the First Affiliated Hospital of Dalian Medical University(KY2014-08).Results No significant differences were observed in baseline characteristics between the two groups (all P > 0.05).In V group and S group,fasting blood glucose (FPG) [(6.4 ± 1.1) vs (11.4 ± 3.0) mmol/L,P=0.008;(5.5±0.8) vs (11.0±2.1) mmol/L,P<0.001],mean blood glucose(MBG) [(7.5 ± 0.8) vs (12.0±1.1) mmol/L,P=0.045;(6.7 ±0.7) vs (12.5 ±1.3) mmol/L,P =0.002],standard deviation of blood glucose (SDBG) (P =0.023,0.036) decreased and homeostasis model assessment (HOMA)-β (P =0.002,0.001) increased significantly after 9 days therapy.The mean of daily differences (MODD) (P =0.027),coefficient of variation-FPG (CV-FPG) (P =0.033) and HOMA-IR (P =0.039) in S group significantly decreased,while postprandial glycemic excursion (PPGE) (P =0.003,0.026,0.011,3 meals respectively)and the low glycemic index(LBGI) (P =0.025) in V group decreased,the peak postprandial level of glucose (△t) was longer compared with before (P =0.028,0.026,0.030,3 meals respectively).After therapy,PPGE in V group significantly became lower than those in S group (P =0.041,0.032,0.036,3 meals respectively),while FPG and MBG in S group were significantly lower than those in V group (P =0.041,0.039).Conclusions Sitagliptin or voglibose combined with SAP can improve glucose control and protect islet function for patients with newly diagnosed T2DM.Sitagliptin has advantages in controlling MBG and FPG compared with voglibose.Voglibose has more striking advantages in reducing the postprandial blood glucose fluctuation.
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