【摘要】  目的  研究甘精胰岛素联合格列美脲及阿卡波糖治疗发生磺脲类治疗失效（SFS）的T2DM患者的临床效果。  方法  选取SFS的T2DM患者48例，采用甘精胰岛素联合格列美脲及阿卡波糖治疗方案，持续3个月，对比治疗前后的血糖及相关指标变化情况。  结果  经3个月治疗后，TG、TC、LDL-C较治疗前降低，HDL-C较治疗前提高，但比较差异无统计学意义（P＞0.05）；FPG[（11.2±1.8） vs （5.4±1.2） mmol/L]、2 hPG[（16.7±5.5） vs （8.7±3.6） mmol/L]、24 h最高血糖值[（20.1±3.5） vs （10.2±2.4） mmol/L]、平均血糖值[(15.6±3.3) vs （6.5±1.3） mmol/L]、HbA₁c[ (10.9±1.3)% vs （7.6±0.8）%]、胰岛素抵抗指数（HOMA-IR）[（13.06±6.35） vs （9.02±3.16）]均较治疗前降低（P＜0.05），FC-P[（2.04±0.16） vs （2.29±0.20） ng/ml]、2 hC-P[（3.59±0.61） vs （4.13±0.72） ng/ml]、胰岛β细胞功能指数（HOMA-β）[（142.64±26.95） vs （178.86±33.92）]均较治疗前提高（P＜0.05）；24 h血糖达标维持时间长于治疗前[（19.2±3.7） vs （2.5±1.6） h]（P＜0.05）。  结论  甘精胰岛素联合格列美脲及阿卡波糖治疗SFS的T2DM患者能有效控制血糖，患者24 h血糖控制效果更佳。

【关键词】  甘精胰岛素；格列美脲；阿卡波糖；磺脲类治疗失效；糖尿病，2型

Efficacy of Glargine in combination with Glimepiride and Acarbose on type 2 diabetic patients with secondary failure of sulfonylurea  LI Xiao-lei, CHEN Ming-wei. Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China

Corresponding author: CHEN Ming-wei, E-mail:Chewl@163.com

【Abstract】  Objective  To investigate the efficacy of Glargine in combination with Glimepiride and Acarbose on T2DM patients with secondary failure of sulfonylurea.  Methods  A total of 48 T2DM patients with secondary failure of sulfonylurea were selected and given Glargine together with Glimepiride and acarbose for 3 months. Blood glucose and related indexes were compared between before treatment and after treatment.  Results  After 3 months of treatment, TG,TC and LDL-C were lower and HDL-C was higher than before treatment, however the difference was not statistically significant. FPG[（11.2±1.8）vs（5.4±1.2）mmol/L], 2 hPG[（16.7±5.5）vs（8.7±3.6） mmol/L], 24 h maximum glucose[（20.1±3.5）vs（10.2±2.4） mmol/L], mean glucose[（15.6±3.3）vs（6.5±1.3）mmol/L], HbA₁c[(10.9±1.3) % vs （7.6±0.8）%] and HOMA-IR[（13.06±6.35）vs（9.02±3.16）] were lower and FC-P[（2.04±0.16）vs（2.29±0.20） ng/ml], 2 hC-P[（3.59±0.61）vs（4.13±0.72） ng/ml] and HOMA-β[（142.64±26.95）vs（178.86±33.92）] were higher after treatment than before treatment [（19.2±3.7）vs（2.5±1.6）h](P＜0.05). The maintenance time of target 24 h glucose level was longer after treatment than before treatment.  Conclusion  Glargine in combination with Glimepiride and Acarbose can effectively control the blood glucose in T2DM patients with secondary failure of sulfonylurea especially for 24 h glucose level.

【Key  words】  Glargine; Glimepiride; Acarbose; Secondary failure of sulfonylurea(SFS); Diabetes mellitus, type 2