糖尿病胰岛素治疗

　　【摘要】 目的 观察经胰岛素治疗但血糖控制不佳的超重或肥胖T2DM患者加用利拉鲁肽的疗效及安全性。 方法 选取经胰岛素治疗但血糖控制不佳的超重或肥胖T2DM患者62例，分为利拉鲁肽治疗组30例和胰岛素治疗组32例。利拉鲁肽组在加用利拉鲁肽时，胰岛素剂量暂减30%，后根据血糖水平调整胰岛素和利拉鲁肽剂量。胰岛素组根据血糖水平调整胰岛素剂量。检测两组治疗前后体重、FPG、HbA1c、FC-P和胰岛素日用量等指标，记录低血糖发生情况及其他不良反应。 结果 利拉鲁肽组体重下降(4.7±6.4)kg，胰岛素组体重增加(1.0±2.1)kg，两组比较差异有统计学意义(P<0.05)。利拉鲁肽、胰岛素组FPG分别下降(2.5±1.1)、(2.9±1.6)mmol/L，HbA1c分别降低(1.8±1.2)%、(1.7±1.3)%，两组比较差异无统计学意义(P>0.05)。利拉鲁肽、胰岛素组FC-P分别升高(0.83±0.35)、(0.16±0.08)ng/ml，两组比较差异有统计学意义(P<0.01)。利拉鲁肽组胰岛素日用量减少(25.9±12.7)U，胰岛素组胰岛素日用量增加(12.1±5.7)U，两组比较差异有统计学意义(P<0.01)。 结论 对超重或肥胖T2DM患者，胰岛素联合利拉鲁肽与胰岛素加量降糖疗效相当，但利拉鲁肽可降低体重，改善胰岛细胞功能。

　　【关键词】 糖尿病，2型;超重;肥胖;胰岛素;利拉鲁肽

　　【Abstract】 Objective To explore the efficacy and safety of insulin treatment alone or in combination with liraglutide in overweight or obese T2DM patients. Methods A total of 62 overweight or obese T2DM patients with unsatisfactory glycemic control under insulin treatment were enrolled in this study. 30 patients were assigned to liraglutide treatment group and 32 patients were still in insulin treatment group. Insulin dose was reduced by 30% upon the initiation of liraglutide, and then the dose of liraglutide and insulin were adjusted according to blood glucose subsequently. Insulin group also received dose titration on the basis of blood glucose. ; Weight, FPG, HbAlc, FC-P, insulin daily dose and other parameters were measured at baseline and after 12 weeks of treatment. The hypoglycemic events and other adverse events were also recorded. Results After treatment, weight loss was observed in the liraglutide group (4.7±6.4)kg while weight gain was seen in insulin group (1.0±2.1)kg (P<0.05). The difference of FPG and HbA1c reduction were not significant in liraglutide group and insulin group: the FPG reduction (2.5±1.1), (2.9±1.6)mmo/L, respectively (P>0.05). HbAlc reduction (1.8±1.2)%, (1.7±1.3)%, respectively (P>0.05). The increase of FC-P in liraglutide group was significantly higher than in insulin group, FC-P increased (0.83±0.35), (0.16±0.08)ng/ml, respectively. Insulin daily dosage was reduced by (25.9±12.7)U in liraglutide group while increased (12.1±5.7)U in insulin group (P<0.01). Conclusion In overweight and obese T2DM patients, treatment with liraglutide and insulin led to greater improvement in weight, islet function and similar improvements in glycaemic control compared with insulin treatment alone.

　　【Key words】Diabetes mellitus，type 2;Overweight;Obese;Insulin;Liraglutide