柯瑞琼+秦永章+肖丽霞+等

[摘要] 目的 观察继往单用预混胰岛素治疗血糖控制不佳的肥胖2型糖尿病患者加用格列美脲的临床疗效。 方法 将本院2013年9月～2014年9月60例单用预混胰岛素治疗>3个月、血糖控制不佳的肥胖2型糖尿病患者随机分为治疗组（A组）和对照组（B组），每组30例，A组患者在调整预混胰岛素剂量的同时，予午餐前口服格列美脲，B组患者维持原治疗方案，继续调整胰岛素剂量，治疗观察3个月，比较治疗前后血糖水平、体质指数（BMI）、胰岛素剂量的变化及低血糖发生情况。 结果 治疗后两组患者FPG、2 hPG、糖化血红蛋白（HbA1c）较治疗前均显著下降（P<0.05），但A组下降更明显（P<0.05），A组BMI及胰岛素剂量较治疗前显著下降（P<0.05），低血糖发生率为6.7%。B组患者的BMI、胰岛素剂量较治疗前显著增加（P<0.05），低血糖发生率为16.7%。 结论 对单用预混胰岛素控制不佳的肥胖2型糖尿病患者，加用格列美脲治疗能有效降低整体血糖水平，可显著减少胰岛素用量，且对患者的体重质量有更大的获益。

[关键词] 格列美脲；预混胰岛素；肥胖；2型糖尿病

[中图分类号] R977.1+5 [文献标识码] A [文章编号] 1674-4721（2015）09（c）-0091-03

Clinical observation of glimepiride added to single treated type 2 diabetes patients with poor glycemic control by pre mixed insulin therapy

KE Rui-qiong QIN Yong-zhang XIAO Li-xia FANG Xiang-nan HONG Shi-hua LV Wei-ming▲

Department of Endocrinology and Metabolism，the First Hospital Affiliated to Gannan Medical University，Ganzhou 341000，China

[Abstract] Objective To observe the clinical effect of glimepiride added to single treated type 2 diabetes patients with poor glycemic control by pre mixed insulin therapy. Methods Sixty ineffective controlled obese type 2 diabetes patients in our hospital from September 2013 to September 2014 were single treated by pre mixed insulin more than 3 months were randomly divided into two groups，treatment group（group A）received aspart 30 combined with glimepiride and control group（group B）continue to adjust the dose of insulin.After treated for 3 months，blood glucose level，body mess index（BMI），insulin dose and incidence of hypoglycemia were compared. Results The fasting blood glucose，postprandial two hours blood glucose and HbA1c between two groups was obviously decreased respectively compared with their pre-treatment（P<0.05）.Group A decreased more significantly（P<0.05）.There was significant difference in BMI and insulin dose before and after treatment in group A（P<0.05）.The incidence of hypoglycemia was 6.7%.On the contrary，there were significant increase in BMI and insulin dose after treated in group B（P<0.05）.The incidence of hypoglycemia was 16.7%. Conclusion For ineffective controlled obese type 2 diabetes patients were single treated by pre mixed insulin，plus glimepiride can effectively reduce blood glucose with lower incidence of hypoglycemia and the dose of insulin，maximum effect on BMI.

[Key words] Glimepiride；Premixed insulin；Obese；Type 2 diabetes mellitus

2型糖尿病常表现为胰岛素分泌不足和胰岛素抵抗，肥胖的患者胰岛素抵抗尤为显著[1]，单独增加外源性胰岛素量所起的疗效将逐渐减弱，甚至联合二甲双胍或阿卡波糖血糖仍不能良好控制[2]，特别是应用预混胰岛素，其组成比例固定且采取固定模式注射，常不能适应机体由于饮食、运动、应激、环境等因素带来的血糖波动[3]，在剂量调整时，易诱发低血糖及体重增加[4]，较难兼顾有效控制空腹和餐后血糖。格列美脲（Glime-piride）作为第3代磺脲类降糖药，其增敏促泌的作用机制能有效对2型糖尿的2个病理生理作用[5]，且与胰岛素联合应用，患者依从性好，降糖效果显著、安全性高，体重增加少。文献报道[6-7]多与基础胰岛素联合应用，磺脲类药物与预混胰岛素联用因疗效及低血糖风险等方面的原因而在学术界存有争议[8]，与预混联用的国内报道较少[9-10]，本研究采用精蛋白门冬胰岛素30注射液治疗血糖控制不佳的肥胖2型糖尿病患者，加用格列美脲观察其临床疗效。 ……