李志杰+张文书+张国平

【摘要】 目的：观察沙格列汀片口服对继发性口服药物失效的老年2型糖尿病（T2DM）患者的疗效。方法：选取2012年3月-2014年3月本院收治的继发口服药物失效的60例老年T2DM患者，按照随机数字表法将其分为A、B组各30例。A组给予口服沙格列汀片，1次/d，B组给予诺和灵30R皮下注射，早、晚各1次，疗程12周，观察比较两组患者治疗前后空腹血糖（FBG）、餐后2 h血糖（P2 hBG）、糖化血红蛋白（HbA1c）、血脂（TG）、体质指数（BMI）的变化。结果：2组均有较好的治疗效果，经12周治疗后两组患者的FBG、P2 hBG、HbA1c和TG均明显低于治疗前，差异均有统计学意义（P<0.01或P<0.05），而两组治疗前后的BMI比较差异无统计学意义（P>0.05）。结论：继发性口服药物失效的老年T2DM患者经口服沙格列汀片及皮下注射诺和灵30R治疗，均有较好的治疗效果，但老年患者口服药物治疗更加方便，服药时间不受进餐影响，遵医依从性更好。

【关键词】 沙格列汀片； 继发性口服降糖药物失效； 老年2型糖尿病

The Clinical Study of Saxagliptin Tablet in Treatment of Elderly Patients with Type 2 Diabetes of Secondary Failure of Oral Drug/LI Zhi-jie，ZHANG Wen-shu，ZHANG Guo-ping.//Medical Innovation of China，2014，11（28）：105-107

【Abstract】 Objective：To observe the curative effect of saxagliptin tablets in treatment of elderly patients with type 2 diabetes mellitus （T2DM） of secondary failure to oral drug.Method：60 elderly patients with T2DM of secondary failure to oral drugs were selected in our hospital from March 2012 to March 2014，they were divided into the group A and the group B according to the random number table method，30 cases in each group.The group A took saxagliptin tablets once a day，and the group B were injected subcutaneously Novolin 30R twice a day for 12 weeks.The fasting blood glucose，2 h postprandial blood glucose levels and HbA1c，triglyceride level，body mass of the two groups before and after treatment were observed and compared.Result：Both group A and B had good effect，the fasting blood glucose，2 h postprandial blood glucose，glycosylated hemoglobin，triglyceride levels of the two groups after 12 weeks of treatment were significantly lower than before treatment，the differences were statistically significant（P<0.05），there was no statistically significant difference in body mass between the two groups before and after treatment（P>0.05）.Conclusion：In patients with T2DM on secondary oral drug failure，both taking saxagliptin tablets and injecting Novolin 30R subcutaneously have good treatment effect，but oral drug therapy is more convenient，and not restricted by meals，thus the patients compliance is better.

【Key words】 Saxagliptin tablet； Secondary oral drug failure； Elderly patient with type 2 diabetes mellitus

First-authors address：The Peoples Hospital of Handan City，Handan 056001，China

doi：10.3969/j.issn.1674-4985.2014.28.036

随着生活方式的改变及人口日益老龄化等因素的影响，我国老年T2DM的发病率迅速增加，目前≥60岁的老年DM发病率>20%，还有约25%糖耐量异常患者[1]。继发治疗失效是指先前能有效控制血糖，治疗后1～3年药物足量而失效者[2]。在老年T2DM患者中，继发性口服药物失效的发生率为每年5%～10%，老年T2DM患者的特点是病程长，胰岛功能差且易发生低血糖[3]。临床上，磺脲类药物及双胍类通过促进β细胞分泌胰岛素及促进周围组织细胞（肌肉等）对葡萄糖的利用和抑制肝糖原异生作用来降低血糖，但随着病情的发展，对老年T2DM患者的血糖控制减弱，导致继发性口服降糖药物失效，成为老年T2DM血糖控制欠佳的临床难题。现……