糖尿病胰岛素治疗

　　【摘要】 目的 评价地特胰岛素联合利拉鲁肽治疗血糖控制不佳的T2DM患者疗效。 方法 选取预混胰岛素治疗血糖控制不佳的T2DM患者32例，采用地特胰岛素联合利拉鲁肽治疗方案，比较治疗前后各项指标，采用动态血糖监测系统(CGMS)评价血糖漂移水平、血糖下面积(AUC)和低血糖发生率等情况。 结果 研究对象治疗后BMI[(26.50±2.30) vs (27.25±2.32)kg/m2]、SBP[(126.55±10.08) vs (137.22±17.42)mmHg]、DBP[(78.22±6.45) vs (85.00±9.54)mmHg]、FPG[(6.52±1.24) vs (10.19±2.99)mmol/L]、2 hPG[(10.51±1.36) vs (15.61±4.37)mmol/L]、HbA1c[(7.26±1.11)% vs (8.57±1.64)%]、TC[(4.19±0.48) vs (5.11±1.51)mmol/L]、LDL-C[(2.55±0.64) vs (3.13±0.73)mmol/L]和胰岛素抵抗指数(HOMA-IR) [(2.60±1.63) vs (3.79±1.98)]较治疗前下降(P<0.05或P<0.01)，FC-P[(4.73±2.39) vs (2.72±1.57)ng/ml]、2 hC-P[(13.33±3.39) vs (6.93±2.20)ng/ml]和HDL-C[(1.21±0.19) vs (1.00±0.27)mmol/L]较治疗前上升(P<0.01)。CGMS结果显示，治疗后血糖平均值[(6.90±0.10) vs (7.90±0.33)mmol/L]、血糖漂移系数[(1.07±0.11) vs (1.87±0.25)]、血糖漂移最大幅度[(1.22±0.69) vs (8.22±1.69)mmol/L]、血糖>7.8 mmol/L AUC[(17.46±2.30)% vs (27.46±6.20)%]及血糖>11.1 mmol/L AUC[(2.02±0.25)% vs (6.20±3.52)%]、低血糖发生率[3.12% vs 45.45%]较治疗前降低(P<0.01)。 结论 地特胰岛素联合利拉鲁肽可有效降低患者BMI、血压、血糖、血脂、HOMA-IR和血糖漂移水平，且低血糖发生率低。

　　【关键词】糖尿病，2型;地特胰岛素;利拉鲁肽;动态血糖监测系统

　　【Abstract】Objective To evaluate the efficacy of liragluride combine with insulin detemir treatment in T2DM patients. Methods A total of 32 T2DM patients with unsatisfactory glycemic control treated with premix insulin were enrolled in this study. All the subjects were treated with insulin detemir combine with liraglutide for 12 weeks. General and biochemical data were recorded at baseline and during follow up. The glucose excursions, the area under the glucose (AUC) and the incidence of hypoglycemia were evaluated according to continuous glucose monitoring system (CGMS). Results After the combined treatment of liralutide and insulin detemir, BMI [(26.50±2.30) vs (27.25±2.32)kg/m2], SBP [(126.55±10.08) vs (137.22±17.42)mmHg], DBP [(78.22±6.45) vs (85.00±9.54)mmHg], FPG [(6.52±1.24) vs (10.19±2.99)mmol/L], 2 hPG[(10.51±1.36) vs (15.61±4.37)mmol/L], HbA1c [(7.26±1.11)% vs (8.57±1.64)%], TC[(4.19±0.48) vs (5.11±1.51)mmol/L], LDL-C [(2.55±0.64) vs (3.13±0.73)mmol/L] and HOMA-IR [(2.60±1.63) vs (3.79±1.98)] decreased significantly (P<0.05 or P<0.01). FC-P [(4.73±2.39) vs (2.72±1.57)ng/ml], 2 hC-P [(13.33±3.39) vs (6.93±2.20)ng/ml] and HDL-C [(1.21±0.19) vs (1.00±0.27)mmol/L] increased significantly (P<0.01). The results of CGMS showed that, mean glucose value [(6.90±0.10) vs (7.90±0.33)mmol/L], glucose excursions coefficient [(1.07±0.11) vs (1.87±0.25)], glucose excursions amplitude peak [(1.22±0.69) vs (8.22±1.69)mmol/L], glucose>7.8 mmol/L AUC [(17.46±2.30)% vs (27.46±6.20)%] and glucose>11.1 mmol/L AUC [(2.02±0.25)% vs (6.20±3.52)%], the incidence of hypoglycemia [3.12% vs 45.45%] decreased significantly(P<0.01). Conclusion The combination of liralutide and insulin detemir are safe and effective in improvement of BMI, blood pressure, blood glucose, blood lipids, HOMA-IR, and the glucose excursions, with low risk of hypoglycemia.

　　【Key words】Diabetes mellitus，type 2;Insulin detemir;Liralutide;Continuous glucose monitoring system (CGMS)