吡格列酮联合胰岛素治疗成人隐匿性自身免疫性糖尿病的疗效观察

目的 观察吡格列酮联合胰岛素治疗成人隐匿性自身免疫性糖尿病( LADA)的疗效.方法 将36例新诊断LADA患者完全随机分为单用胰岛素治疗组(17例)和吡格列酮联合胰岛素治疗组(19例).观察12个月,记录比较2组患者治疗后空腹血糖(FPG)、餐后2h血糖(2 hPG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(Homa-IRI)和体重的变化,以及胰岛素用量和低血糖发生情况.结果 治疗12个月后,与治疗前比较,吡格列酮联合胰岛素治疗组和单用胰岛素治疗组患者FPG、2 hPG、HbA1c均得到良好控制前者分别为(6.4±1.2) mmol/L比(9.1±1.1) mmol/L,(8.7±2.2)mmol/L比(19.2±2.4) mmol/L,(5.8±1.1)％比(8.4±1.3)％,后者分别为(6.9±1.2) mmol/L比(8.4±1.2) mmol/L,(9.0±1.6)mmol/L比(18.1±2.6)mmol/L,(7.2±1.2)％比(8.2±1.4)％,均P＜0.05].治疗后吡格列酮联合胰岛素组HbAlc、Homa-IRI、胰岛素用量、低血糖发生次数均低于单用胰岛素组(5.8±1.1)％比(7.2±1.1)％,1.16±0.25比1.45±0.28,(17±4) U/d比(27±8)U/d,(0.8±0.3)次/例比(1.6±0.8)次/例,均P＜0.05].结论 吡格列酮联合胰岛素治疗早期LADA患者可更有效控制血糖,减少胰岛素用量及低血糖发生,改善胰岛素抵抗.

Therapeutic effects of pioglitazone combined with insulin on newly diagnosed latent autoimmune diabetes in adult

Objective To observe the therapeutic effects of pioglitazone combined with insulin on patients with newly diagnosed latent autoimmune diabetes in adult（LADA）. Methods All 36 LADA patients were randomly divided into insulin group （17 cases） and pioglitazone plus insulin group （19 cases）. Seventeen patients in insulin group were treated with insulin and 19 patients in pioglitazone plus insulin group were treated with insulin and pioglitazone during twelve months. The changes of fasting plasma glucose （FPG）, 2-hour plasma glucose （2hPG）, glycolated hemoglobin （HbA1 c）, insulin resistance index （Homa-IRI）, body weight, insulin dosage and hypoglycemia events in different groups were compared after treatment for twelve months. Results Compared to pre-treatment, the levels of FPG, 2 hPG, and HbAlc in pioglitazone plus insulin group （6.4±1.2） mmol/L vs （9. 1 ±1.1 ） mmol/L, （ 8. 7±2. 2） mmol/L vs （ 19. 2± 2.4） mmol/L, （ 5.8 ± 1.1 ） % vs （ 8.4±1.3 ） % ] and in insulin group （ 6. 9 ±1.2 ） mmol/L vs （ 8.4±1.2 ） mmol/L, （ 9. 0 ±1.6 ） mmol/L vs （ 18.1± 2. 6 ） mmol/L, （ 7.2± 1.2 ） % vs （8.2±1.4） % ] after treatment for 12 months were lower（ all P 〈0.05）. The levels of Homa-IRI, HbAlc, insulin dosage and hypoglyeemia events in pioglitazone plus insulin group were lower than those in insulin group （5.8±1.1）% vs （7.2±1.1 ）%, 1.16±0. 25 vs 1.45±0. 28, （17±4）U/d vs （27±8）U/d,（0. 8±0. 3）times vs （1.6±0. 8 ）times] （P 〈 0. 05 ）, while the difference of body weight between the two group had no statistical signifieanee （ P 〉 0. 05 ）. Conclusion The method of pioglitazone combined with insulin treatment can more effectively control blood sugar, reduce the dosage of the insulin and hypoglycemia events and improve insulin resistance in newly diagnosed LADA patients.