摘要
目的 探讨地特胰岛素联合阿卡波糖治疗对初诊大理白族老年2型糖尿病的临床疗效并采用实时动态血糖监测系统(rt-CGMS)观察血糖波动的变化。方法 120例初诊大理白族老年2型糖尿病患者,按照随机数字表法分为观察组和对照组,每组60例。观察组给予地特胰岛素联合阿卡波糖治疗,对照组单纯给予阿卡波糖治疗,并在治疗前后对所有患者进行rt-CGMS监测。比较两组患者治疗前后体格及生化指标[空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、体质量指数(BMI)]、胰岛功能指标[胰岛分泌指数(HOMA-β)、胰岛抵抗指数(HOMA-IR)]、血糖波动指标[血糖水平标准差(SDBG)、最大血糖波动幅度(LAGE)、平均血糖波动幅度(MAGE)、平均血糖水平(MBG)、血糖>11.1 mmol/L的时间百分比(PT11.1)、血糖<3.9 mmol/L的时间百分比(PT3.9)]及不良事件发生情况。结果 治疗后,两组患者FPG、2 h PG、HbA1c、BMI均较本组治疗前下降,差异具有统计学意义(P<0.05);观察组患者FPG(7.6±0.5)mmol/L、2 h PG(8.1±0.6)mmol/L、HbA1c(6.1±0.4)%低于对照组的(8.2±0.5)mmol/L、(8.9±0.6)mmol/L、(6.8±0.5)%,但BMI(24.62±1.29)kg/m^(2)高于对照组的(23.98±1.38)kg/m^(2),差异具有统计学意义(P<0.05)。观察组患者胃肠道反应发生率6.67%低于对照组的25.00%,差异具有统计学意义(P<0.05)。治疗后,两组患者HOMA-β均高于本组治疗前,差异具有统计学意义(P<0.05)。治疗后,两组患者HOMA-IR均较本组治疗前降低,且观察组患者低于对照组,差异具有统计学意义(P<0.05)。治疗后,两组患者MAGE、SDBG、LAGE、MBG、PT11.1均低于本组治疗前,差异具有统计学意义(P<0.05);治疗后,观察组患者MAGE、SDBG、LAGE均低于对照组,差异具有统计学意义(P<0.05)。结论 地特胰岛素联合阿卡波糖治疗初诊大理白族老年2型糖尿病的临床疗效确切,胃肠道不良反应少,可减少老年人多重用药的安全风险,并有助于改善胰岛功能。在治疗过程中使用rt-CGMS有助于进一步控制患者的血糖水平,稳定血糖波动。
Objective To discuss the clinical effect of insulin determir combined with acarbose in elderly,newly diagnosed type 2 diabetes mellitus patients of the Dali Bai Autonomous Prefecture and changes of blood glucose fluctuation by real-time continuous blood glucose monitoring system(rt-CGMS).Methods A total of 120 cases of elderly,newly diagnosed diabetes mellitus patients of Dali Bai Autonomous Prefecture were divided into observation group and control group according to the random numerical table,with 60 cases in each group.The observation group was treated with insulin detemir combined with acarbose,the control group was treated with acarbose alone.All patients were monitored by rt-CGMS before and after treatment.Both groups were compared in terms of physique and biochemical indexes[fasting plasma glucose(FPG),2 h postprandial glucose(2 h PG),glycosylated hemoglobin(HbA1c),body mass index(BMI)],pancreatic islet function indexes[homeostasis model assessment insulin-β(HOMA-β),homeostasis model assessment insulin-resistance index(HOMA-IR)],blood glucose fluctuation indexes[standard deviation of blood glucose(SDBG),largest amplitude of glycemic excursions(LAGE),mean amplitude of glycemic excursions(MAGE),mean blood glucose(MBG),percentage of time when blood glucose was>11.1 mmol/L(PT11.1),the percentage of time when blood glucose was<3.9 mmol/L(PT3.9)]and the occurrence of adverse events.Results After treatment,the FPG,2 h PG,HbA1c and BMI of the two groups were decreased compared with those of this group before treatment,and the differences were statistically significant(P<0.05).The FPG(7.6±0.5)mmol/L,2 h PG(8.1±0.6)mmol/L,and HbA1c(6.1±0.4)%in the observation group were lower than(8.2±0.5)mmol/L,(8.9±0.6)mmol/L,and(6.8±0.5)%in the control group;but the BMI(24.62±1.29)kg/m^(2) was higher than(23.98±1.38)kg/m^(2) in the control group;all the differences were statistically significant(P<0.05).The incidence of gastrointestinal reactions 6.67%in the observation group was lower than 25.00%in the control group,and the difference was statistically significant(P<0.05).After treatment,the HOMA-βin the two groups was higher than that before treatment in this group,and the difference was statistically significant(P<0.05).After treatment,the HOMA-IR of the two groups was lower than that of this group before treatment,and the observation group was lower than the control group,and the differences were statistically significant(P<0.05).After treatment,the MAGE,SDBG,LAGE,MBG,PT11.1 of the two groups were lower than those of this group before treatment,and the differences were statistically significant(P<0.05).After treatment,the MAGE,SDBG and LAGE of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).Conclusion Insulin detemir combined with acarbose has definite clinical efficacy and less gastrointestinal reactions in elderly,newly diagnosed type 2 diabetes mellitus patients of the Dali Bai Autonomous Prefecture,and can significantly improve the clinical efficacy,reduce the safety risk of multiple medications in the elderly and help improve islet function.The use of rt-CGMS during treatment helps to further control patients'blood glucose levels and stabilize blood glucose fluctuations.
作者
杨蕾
黎伟娟
闻海梅
胡学琴
陈晓云
YANG Lei;LI Wei-juan;WEN Hai-mei(Department of Geriatrics,People's Hospital of Dali Bai Autonomous Prefecture,Dali 671000,China)
出处
《中国实用医药》
2022年第15期1-6,共6页
China Practical Medicine
基金
2021年云南省教育厅科学研究基金项目(项目编号:2021J0375)。
关键词
老年2型糖尿病
临床疗效
老年人多重用药
胰岛功能
实时动态血糖监测系统
血糖波动
Type 2 diabetes mellitus in the elderly
Clinical efficacy
Multiple medication in the elderly
Islet function
Real-time continuous blood glucose monitoring system
Blood glucose fluctuation
