糖尿病临床研究

　　[摘要] 目的 探讨利拉鲁肽联合胰岛素治疗新诊断肥胖T2DM的临床疗效及其安全性。方法 筛选新诊断肥胖T2DM患者76例，随机分为观察组和对照组，每组各38例。对照组予胰岛素联合二甲双胍，观察组在此基础上加用利拉鲁肽。治疗16周，比较两组的临床疗效及不良反应。 结果 与治疗前相比，两组糖基化血红蛋白[对照组:(6.90±0.75)% vs (10.94±1.55)%;观察组:(5.86±0.76)% vs (11.41±1.43)%]、稳态模型胰岛素抵抗指数(HOMA-IR)[对照组:(2.00±0.35)vs(3.40±0.63);观察组:(1.60±0.54) vs (3.38±0.66)]下降( P均<0.05)，而稳态模型胰岛β细胞功能指数(HOMA-β)升高[(对照组:(33.56±7.06) vs (13.34±4.07);观察组:(49.88±10.58) vs (12.53±3.25)](P<0.05);观察组BMI降低[ ( 26.58±0.93) vs (28.89±1.19)kg/m2]P<0.01。与对照组相比，观察组治疗后HbA1c[(5.86±0.76) % vs (6.90±0.75)%、HOMA-IR [(1.60±0.54) vs (2.00±0.35)]下降，HOMA-β升高[(49.88±10.58) vs (33.56±7.06) ](P<0.05);观察组低血糖发生率升高 [(81.6% vs 72.1%)](P<0.05)。两组均无严重低血糖事件发生。 结论 利拉鲁肽联合胰岛素治疗新诊断肥胖T2DM可明显降低血糖和体重，改善胰岛β细胞功能，且无严重不良反应发生。

　　[关键词]糖尿病,2型;新诊断;肥胖;利拉鲁肽;胰岛素

　　【Abstract】Objective To assess the clinical efficacy and safety of liraglutide combined with insulin in the treatment of newly diagnosed type 2 diabetes with obesity. Methods A total of 76 patients with newly diagnosed type 2 diabetes with obesity were selected, and were randomly divided to the observation group and the control group, 38 cases in each group. The control group was treated with insulin and diformin, and the observation group was added liraglutide treatment on that basis. After 16 weeks treatment, clinical efficacy and adverse reactions between two groups were compared. Results After treatment, glycated hemoglobin in two groups [The control group (6.90±0.75)% vs (10.94±1.55)%, the observation group (5.86±0.76)% vs (11.41±1.43)%] and homeostatic model insulin resistance index (HOMA-IR) [The control group (2.00±0.35) vs (3.40±0.63), the observation group (1.60±0.54) vs (3.38±0.66)] were decreased (all P<0.05), while homeostatic model islet β-cell function index (HOMA-β) was elevated [The control group (33.56±7.06) vs (13.34±4.07), the observation group (49.88±10.58) vs (12.53±3.25)] (P<0.05). The body mass index (BMI) was decreased in observation group [(26.58±0.93) vs (28.89±1.19) kg/m2](P<0.01). After treatment, The HbA1c (5.86±0.76)% vs (6.90±0.75)%, and the HOMA-IR (1.60±0.54) vs (2.00±0.35) were decreased in observation group compared with the control group, while the HOMA-β was increased [(49.88±10.58) vs(33.56±7.06)] (P<0.05); The incidence of hypoglycemia was elevated in the observation group (81.6% vs 72.1%) (P<0.05). Severe hypoglycemia events were not occurred in two groups. Conclusion The combination therapy of liraglutide and insulin in newly diagnosed type 2 diabetes with obesity can induce a significant reduction in blood glucose and body weight, and improve the function of islet β-cell, without severe adverse reactions occurred.

　　【Key words】Diabetes mellitus, type 2; Newly diagnosed; Obesity; Liraglutide; Insulin