甘精胰岛素联合那格列奈在继发性磺脲类失效的2型糖尿病中的应用

目的探讨甘精胰岛素联合那格列奈治疗继发性磺脲类失效的2型糖尿病的疗效及安全性。方法 30例口服降糖药血糖控制不理想的2型糖尿病患者(GHbA1c≥9%)按1∶1随机分为甘精胰岛素治疗组和精蛋白锌重组赖脯胰岛素混和注射液(25R)对照组。观察空腹C肽(F-cp)及餐后C肽(P-cp),血糖控制、糖化血红蛋白(HbAlc)达标率和低血糖事件发生频率。结果治疗后两组F-cp及P-cp均较治疗前明显升高(P<0.05),两组FBG及餐后2h血糖均较基线水平明显下降(P<0.05),两组下降幅度及糖化血红蛋白(HbAlc)达标率比较差异无统计学意义(P>0.05),但治疗组低血糖发生率明显低于对照组。结论甘精胰岛素联合那格列奈治疗继发性磺脲类药物失效的2型糖尿病患者,可以良好地控制高血糖,部分恢复胰腺β细胞功能,且低血糖发生率显著降低,安全性好。

Effect of insulin glargine plus nateglinide in secondary sulfonylurea failure of type 2 diabetes

Objective To investigate the effect of insulin glargine combined nateglinide on controlling blood glucose level and the risk of hypoglycemia in type 2 diabetic patients with secondary sulfonylurea failure. Methods Thirty patients with glyeemia controlled （ GHbA1c≥9% ） were randomly divided into two groups. The treatment group （ 15 cases） was given insulin glargine plus nateglinide while the control group （ 15 cases） was given premixed insulin analogs （ Humanlog25）. F - cp, P - cp, glucose control level, the success rate of GHbAle and hypoglycemia events were observed. Results The F - cp and P -cp of both groups were increased significantly （ P 〈 0. 05 ） ; while the fasting and postprandial blood glucose of both groups were decreased significantly （ P 〈 0. 05 ）. There was no difference in the decrease range of blood glucose and success rate of GHbA1c between two groups （ P 〉 0.05 ）. Compared to the control group, the incidence of hypoglycemia was lower in the treatment group. Conclusion The combination of insulin glargine plus nateglinide controls blood sugar concentration effectively and recovers the function of pancreatic β - cell partly in seeandary sulfonylurea failure of type 2 diabetic patients.