中国医药指南
中國醫藥指南
중국의약지남
CHINA MEDICINE GUIDE
2014年
6期
28-30,31
,共4页
卢林娜%高政南%朱珠%罗兰%李欣宇%牛敏%侯桂梅
盧林娜%高政南%硃珠%囉蘭%李訢宇%牛敏%侯桂梅
로림나%고정남%주주%라란%리흔우%우민%후계매
糖尿病%2型%艾塞那肽%地特胰岛素%动态血糖监测%正糖钳夹%血糖波动
糖尿病%2型%艾塞那肽%地特胰島素%動態血糖鑑測%正糖鉗夾%血糖波動
당뇨병%2형%애새나태%지특이도소%동태혈당감측%정당겸협%혈당파동
diabetes mellitus%Type 2%Exenatide%Insulin detemir%Continuous glucose monitoring system%Hyperinsuline-mic-euglycemic clamp technique%Glycemic excursion
目的:应用动态血糖监测(CGM)、高胰岛素-正糖钳夹技术(hyperinsuline-mic-euglycemic clamp technique)评价口服降糖药控制不佳的2型糖尿病患者加用艾塞那肽及地特胰岛素对血糖波动、胰岛素敏感性及体质量的影响。方法选取2011年3月至2012年6月于大连市中心医院住院的20例口服降糖药控制不佳的2型糖尿病患者,随机分为艾塞那肽组及地特胰岛素组,在原有治疗方案的基础上加用艾塞那肽及地特胰岛素治疗,治疗期为3个月,测定20例患者治疗前后身高、体质量、糖化血红蛋白(HbA1c)等指标,治疗前后分别应用动态血糖监测及高胰岛素-正糖钳夹技术评估患者的血糖波动、胰岛素敏感性等相关指标。结果经过3个月的治疗,艾塞那肽组及地特胰岛素组HbA1c较前明显下降[分别为(8.31±0.99)vs(6.80±0.77)mmol/L,(8.09±1.66)vs(6.94±1.25)mmol/L(均P<0.05)]。动态血糖监测显示治疗后艾塞那肽组的日平均血糖(MBG)、血糖水平标准差(SDBG)、平均血糖波动幅度(MAGE)较前明显下降[分别为(10.16±0.60)vs(8.26±0.76)mmol/L,(2.25±0.55)vs(1.42±0.50)mmol/L,(5.38±1.65)vs(3.06±1.58)(均P<0.05)],地特胰岛素组上述指标及两组日间平均血糖绝对差(MODD)治疗前后差异无统计学意义(P>0.05)。治疗后艾塞那肽组M值较前明显升高(3.10±1.29 vs(4.44±1.26) mg/(min?kg),P<0.05),体质量及体质量指数(BMI)较前明显下降[分别为(81.85±8.57) vs(79.51±8.24) kg,(28.27±3.39)vs(27.46±3.17) kg/m2,(均P<0.05)],地特胰岛素组M值、体质量及BMI治疗前后差异无统计学意义(P>0.05)。治疗前后两组HbA1c、MBG、SDBG、MAGE、MODD、体质量、BMI及M值比较差异无统计学意义(P>0.05)。治疗期间无严重低血糖发生。结论口服药控制不佳的2型糖尿病患者加用艾塞那肽及地特胰岛素治疗,能有效地控制血糖,同时艾塞那肽尚能减轻血糖波动,改善胰岛素敏感性及减轻体质量,但与地特胰岛素组比较无明显差异。
目的:應用動態血糖鑑測(CGM)、高胰島素-正糖鉗夾技術(hyperinsuline-mic-euglycemic clamp technique)評價口服降糖藥控製不佳的2型糖尿病患者加用艾塞那肽及地特胰島素對血糖波動、胰島素敏感性及體質量的影響。方法選取2011年3月至2012年6月于大連市中心醫院住院的20例口服降糖藥控製不佳的2型糖尿病患者,隨機分為艾塞那肽組及地特胰島素組,在原有治療方案的基礎上加用艾塞那肽及地特胰島素治療,治療期為3箇月,測定20例患者治療前後身高、體質量、糖化血紅蛋白(HbA1c)等指標,治療前後分彆應用動態血糖鑑測及高胰島素-正糖鉗夾技術評估患者的血糖波動、胰島素敏感性等相關指標。結果經過3箇月的治療,艾塞那肽組及地特胰島素組HbA1c較前明顯下降[分彆為(8.31±0.99)vs(6.80±0.77)mmol/L,(8.09±1.66)vs(6.94±1.25)mmol/L(均P<0.05)]。動態血糖鑑測顯示治療後艾塞那肽組的日平均血糖(MBG)、血糖水平標準差(SDBG)、平均血糖波動幅度(MAGE)較前明顯下降[分彆為(10.16±0.60)vs(8.26±0.76)mmol/L,(2.25±0.55)vs(1.42±0.50)mmol/L,(5.38±1.65)vs(3.06±1.58)(均P<0.05)],地特胰島素組上述指標及兩組日間平均血糖絕對差(MODD)治療前後差異無統計學意義(P>0.05)。治療後艾塞那肽組M值較前明顯升高(3.10±1.29 vs(4.44±1.26) mg/(min?kg),P<0.05),體質量及體質量指數(BMI)較前明顯下降[分彆為(81.85±8.57) vs(79.51±8.24) kg,(28.27±3.39)vs(27.46±3.17) kg/m2,(均P<0.05)],地特胰島素組M值、體質量及BMI治療前後差異無統計學意義(P>0.05)。治療前後兩組HbA1c、MBG、SDBG、MAGE、MODD、體質量、BMI及M值比較差異無統計學意義(P>0.05)。治療期間無嚴重低血糖髮生。結論口服藥控製不佳的2型糖尿病患者加用艾塞那肽及地特胰島素治療,能有效地控製血糖,同時艾塞那肽尚能減輕血糖波動,改善胰島素敏感性及減輕體質量,但與地特胰島素組比較無明顯差異。
목적:응용동태혈당감측(CGM)、고이도소-정당겸협기술(hyperinsuline-mic-euglycemic clamp technique)평개구복강당약공제불가적2형당뇨병환자가용애새나태급지특이도소대혈당파동、이도소민감성급체질량적영향。방법선취2011년3월지2012년6월우대련시중심의원주원적20례구복강당약공제불가적2형당뇨병환자,수궤분위애새나태조급지특이도소조,재원유치료방안적기출상가용애새나태급지특이도소치료,치료기위3개월,측정20례환자치료전후신고、체질량、당화혈홍단백(HbA1c)등지표,치료전후분별응용동태혈당감측급고이도소-정당겸협기술평고환자적혈당파동、이도소민감성등상관지표。결과경과3개월적치료,애새나태조급지특이도소조HbA1c교전명현하강[분별위(8.31±0.99)vs(6.80±0.77)mmol/L,(8.09±1.66)vs(6.94±1.25)mmol/L(균P<0.05)]。동태혈당감측현시치료후애새나태조적일평균혈당(MBG)、혈당수평표준차(SDBG)、평균혈당파동폭도(MAGE)교전명현하강[분별위(10.16±0.60)vs(8.26±0.76)mmol/L,(2.25±0.55)vs(1.42±0.50)mmol/L,(5.38±1.65)vs(3.06±1.58)(균P<0.05)],지특이도소조상술지표급량조일간평균혈당절대차(MODD)치료전후차이무통계학의의(P>0.05)。치료후애새나태조M치교전명현승고(3.10±1.29 vs(4.44±1.26) mg/(min?kg),P<0.05),체질량급체질량지수(BMI)교전명현하강[분별위(81.85±8.57) vs(79.51±8.24) kg,(28.27±3.39)vs(27.46±3.17) kg/m2,(균P<0.05)],지특이도소조M치、체질량급BMI치료전후차이무통계학의의(P>0.05)。치료전후량조HbA1c、MBG、SDBG、MAGE、MODD、체질량、BMI급M치비교차이무통계학의의(P>0.05)。치료기간무엄중저혈당발생。결론구복약공제불가적2형당뇨병환자가용애새나태급지특이도소치료,능유효지공제혈당,동시애새나태상능감경혈당파동,개선이도소민감성급감경체질량,단여지특이도소조비교무명현차이。
Objective To evaluate the change of glycemic excursion, insulin sensitivity and BMI in patients with type 2 diabetes mellitus, who had poor therapeutic effect with oral antidiabetic medications by continuous glucose monitoring system,hyperinsuline-mic-euglycemic clamp technique. Methods 20 patients with type 2 diabetes failing to achieve glycaemic control with oral antidiabetic medications only in Dalian Municipal Central Hospital from March 2011 to june 2012 were selected, randomly divided into Exenatide group and insulin Detemir group, in the basis of the original treatment plus Exenatide and Detemirt, last for 3 months.The parameters were measured before and after treatment included height, weight, glycated hemoglobin.Using CGM and hyperinsuline-mic-euglycemic clamp technique to assess blood sugar fluctuation, insulin sensitivity etc. Results After 3 months’ treatment, both Exenatide group and insulin Detemir group have a significant decrease in HbA1c than before respectively[8.31±0.99 vs (6.80±0.77)mmol/L, (8.09±1.66)vs(6.94±1.25)mmol/L (all above P<0.05)].CGM show that MBG, SDBG, MAGE in Exenatide group were significantly decreased than before, respectively [10.16 ±0.60vs(8.26±0.76)mmol/L, (2.25±0.55)vs(1.42±0.50)mmol/L, (5.38± 1.65)vs(3.06±1.58)(all above P<0.05)], The difference in insulin detemir group of the above indexes and MODD was not statistically significant before and after treatment(P>0.05). M value in Exenatide group was significantly increased than before(3.10±1.29)vs(4.44±1.26)mg/(min?kg),P<0.05), body weight and BMI in Exenatide was decreased, respectively[81.85±8.57vs79.51±8.24 kg, (28.27±3.39)vs(27.46±3.17)kg/m2(all above P<0.05)]. M value, body weight and BMI in Detemirt group have no statistically significant difference before and after treatment(P>0.05). There was no statistical difference in HbA1c, MBG, SDBG, MAGE, MODD, body weight,BMIand M value.There was no serious hypoglycemia. Conclusion Exenatide or Once-daily insulin detemir added to oral antidiabetic drugs in poorly controlled type 2 diabetes patients could improved glycemic control, Exenatide can also reduce blood sugar fluctuation, improve insulin sensitivity and lose weight, but the difference between the two groups was not evident.