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新诊断超重/肥胖2型糖尿病在短期胰岛素强化治疗后转换不同降糖方案的临床疗效和安全性研究 预览

Clinical efficacy and safety of different hypoglycemic regimens after short-term intensive insulin therapy in newly diagnosed overweight/obese type 2 diabetes mellitus
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摘要 目的探讨新诊断超重/肥胖2型糖尿病在短期胰岛素强化治疗后转换不同治疗模式的临床有效性和安全性。方法 98例新诊断超重肥胖2型糖尿病患者均符合糖化血红蛋白(Hb A1C)≥9. 0%或空腹血糖(FPG)≥11. 1 mmol/L,住院进行短期胰岛素强化治疗1周后,随机纳入基础胰岛素联合口服药物组(A组)、单口服降糖药组(B组)、利拉鲁肽联合口服降糖药组(C组),观察12周,比较不同方案临床疗效和安全性。结果 (1)三组患者Hb A1C达标率(Hb A1C≤7. 0%)分别为69%、68%、90%(P> 0. 05);(2)三组患者低血糖发生率分别为47%、19%、10%(P <0. 01);(3)三组患者稳态模型胰岛β细胞功能指数(HOMA-β)均较治疗前明显升高(P <0. 05),稳态模型胰岛素抵抗指数(HOMA-IR)均较治疗前显著减少(P <0. 01),与A组治疗后相比,B组和C组治疗后HOMA-IR明显减少(P <0. 05);(4)各组血清总胆固醇(TC)均显著下降(P <0. 01);(5) A组体质量指数(BMI)(P <0. 01)和腰围(P <0. 05)较治疗前均增加,C组BMI(P <0. 01)和腰围(P <0. 05)较治疗前均减少。结论新诊断超重/肥胖2型糖尿病短期胰岛素强化治疗后选用胰高血糖素样肽(GLP-1)受体激动剂联合二甲双胍治疗不仅能维持血糖稳定,而且能减轻体质量和腰围、减少低血糖风险。 Objective To investigate the clinical efficacy and safety of different treatment modalities for newly diagnosed overweight/obese type 2 diabetes mellitus after short-term intensive insulin therapy. Methods After one week intensive insulin therapy,98 patients with newly diagnosed type 2 diabetes were randomly divided into basic insulin combined with oral drug group( group A),single oral hypoglycemic drug group( group B) and liraglutide combined oral hypoglycemic drug group( group C). Each patient was in line with the characteristics: glycosylated hemoglobin A1 C( HbA1 C) ≥9. 0% or fasting plasma glucose( FPG) ≥11. 1 mmol/L. The clinical efficacy and safety were compared after 12 week’s treatment of blood glucose controlling measures. Results(1) The blood glucose compliance rates of three groups( HbA1 C was less than or equal to 7. 0%) were 69%,68%,and 90% respectively( P > 0. 05);(2) The hypoglycemia occurrence rates of the three groups were 47%,20%,and 9% respectively( P < 0. 01);(3) The HOMA-β indexes of three groups were obviously higher than that before treatment( P< 0. 05),while the HOMA-IR indexes were evidently reduced( P < 0. 01). Compared with group A,HOMA-IR in group B and group C decreased significantly after treatment( P < 0. 05);(4) The serum total cholesterol of three groups were evidently decreased after treatment( P < 0. 01);(5) The BMI( P < 0. 01) and the waistline( P < 0. 05)of group A was increased compared with that before treatment. BMI( P < 0. 01) and waist circumference( P <0. 05) decreased in group C. Conclusion GLP-1 receptor agonists combined with metformin in newly diagnosed overweight or obese type 2 diabetes can not only effectively control hyperglycemia,but also reduce weight and waist circumference,reduce the risk of hypoglycemia.
作者 徐礼五 钟兴 齐晓玲 李晓蕾 陈斌 Xu Liwu;Zhong Xing;Qi Xiaoling(Dept of Endocrinology,The First Affiliated Hospital of Anhui University of Science&Technology,Huainan 232007;Dept of Endocrinology,The Second Affiliated Hospital of Anhui Medical University,Hefei 230601)
出处 《安徽医科大学学报》 CAS 北大核心 2019年第2期303-306,共4页 Acta Universitis Medicinalis Anhui
基金 安徽省高校自然科学研究重点项目(编号:KJ2017A174) 蚌埠医学院院基金(编号:Byky1292NF).
关键词 新诊断2型糖尿病 超重 肥胖 胰岛素强化治疗 利拉鲁肽 newly diagnosed type 2 diabetes mellitus overweight obesity intensive therapy liraglutide
作者简介 徐礼五,男,硕士,副主任医师,责任作者,E-mail:xlwzyx1998@126.com.
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