摘要
目的:观察低精蛋白锌胰岛素(NPH)与预混胰岛素联合口服降糖药在新诊断2型糖尿病中的有效性及安全性。方法:将就诊于天津医科大学代谢病医院门诊新诊断的空腹血糖(FBG)≥12mmol.L-1或糖化血红蛋白(HbA1C)≥9.5%的128例2型糖尿病(T2DM)患者随机分成两组,每组64例,分别给予NPH联合瑞格列奈、二甲双胍治疗和预混胰岛素联合阿卡波糖、二甲双胍治疗。治疗12周后,观察两组FBG、餐后血糖(2hPBG)、HbA1C、腰臀围及体重的变化,以及低血糖的情况。结果:治疗12周后,两组FPG、2hPPG、HbA1C均较治疗前下降(P<0.01),但NPH组下降更明显(P<0.01)。NPH联合口服药组FBG、2hPBG、HbA1C分别由(14.3±2.1)mmol.L-1、(18.6±3.8)mmol.L-1、(11.5±2.1)%降至(6.3±1.1)mmol.L-1、(8.2±1.7)mmol.L-1、(6.6±1.6)%,均P<0.01;预混胰岛素联合口服药组FBG、2hPBG、HbA1C分别由(14.1±2.1)mmol.L-1、(18.4±3.7)mmol.L-1、(11.3±2.1)%降至(7.1±1.7)mmol.L-1、(9.1±2.0)mmol.L-1、(7.7±1.3)%,均P<0.01。NPH联合口服药组体重由(65.2±11.7)kg增加至(66.1±10.9)kg;预混胰岛素联合口服药组体重由(66.0±11.6)kg增加至(67.8±10.8)kg(P=0.01)。NPH用量平均(9±3.6)U.d-1明显少于预混胰岛素(17±3.3)U.d-1(P=0.0001)。NPH联合口服药组HbA1C达标率(87.5%)优于预混胰岛素联合口服药组(73.4%),P=0.045。NPH联合口服药组低血糖发生率明显低于预混胰岛素联合口服药组(P=0.042)。结论:与预混胰岛素组相比,NPH联合瑞格列奈和二甲双胍治疗新诊断血糖较高的2型糖尿病患者疗效更好,胰岛素用量少,对体重的影响小,低血糖风险低。
Objective：To observe the efficacy and safety of NPH versus premixed insulin combined with oral antidiabetic drugs in the treatment of newly diagnosed type 2 diabetic patients.Methods：The 128 newly diagnosed type 2 diabetic patients which FBG was at least 12 mmol/L or HbA1C at least 9.5%were randomly assigned to receive insulin NPH and OADs（repaglinide and metformin） or premixed insulin and OADs（acarbose and metformin）,respectively,for 12 weeks.Fasting blood glucose,2-hour past-meal blood glucose,blood hem-atoglobin A1C,waistline,hipline,body weight and the frequency of hypoglycemia were analyzed before and after the treatment.Results：After the 12-week of treatment,the levels of FBG,2hPBG,and HbA1C of the two groups were decreased（P﹤0.01）,while the decrease in the NPH group was more significant（P﹤0.01）.the levels of FBG,2hPBG,and HbA1C were all decreased significantly in NPH group than those of baselines,from（14.3±2.1） mmol/L,（18.6±3.8） mmol/L,（11.5±2.1）% to（6.3±1.1） mmol/L,（8.2±1.7） mmol/L,（6.6±1.6）%,respectively;all P﹤0.01.And those indicator were all significantly declined too in premixed insulin group,from（14.1±2.1） mmol/L,（18.4±3.7） mmol/L,（11.3±2.1）% to（7.1±1.7） mmol/L,（9.1±2.0） mmol/L,（7.7±1.3）%,respectively,and all P﹤0.01.The increase of body weight in NPH group（0.88kg） was inferior to premixed insulin group（1.84kg）（P﹤0.01）.The doses of NPH（9±3.6）U/d was significantly lower than these of premixed insulin（17±3.3）U/d（P=0.0001）.As HbAIC﹤7.0% for target,targeting of HbA1C in NPH group（87.5%）was superior to the premixed insulin group（73.4%）（P=0.045）.The incidence of hypoglycemia in NPH group was inferior to the premixed insulin group（P=0.042）.Conclusion：As compared with premixed insulin plus acarbose or metformin,the effect of insulin NPH and OADs（repaglinide and metformin） is better in newly diagnosed patients with less doses of insulin,less incidence of hypoglycemia and less influence on body weight.
出处
《临床药物治疗杂志》
2013年第1期12-15,共4页
Clinical Medication Journal
基金
国家自然科学基金项目(30971393
81070645)
天津市自然科学基金项目(10JCYBJC12000)
天津市卫生局科技基金重点项目及一般项目(09KZ01
09KZ89)
天津医科大学科技基金资助项(2009ky25)
作者简介
通信作者：于德民E-mail：yudemintij@126.com
