利拉鲁肽治疗血糖控制不佳的2型糖尿病患者的临床疗效及安全性研究
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摘要
目的 :探讨利拉鲁肽治疗血糖控制不佳的2型糖尿病患者的临床疗效及安全性研究。方法 :选择2015年5月～2017年5月我院接诊的90例血糖控制不佳的2型糖尿病患者为研究对象。按照随机数表法将患者分为观察组(n=45)和对照组(n=45)。观察组使用利拉鲁肽治疗,对照组给予甘精胰岛素治疗。比较两组患者治疗前后血糖、血脂和72h动态血糖监测结果的变化。结果 :治疗后,两组患者血清空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbAlc)水平均低于治疗前,观察组患者血清FPG、2hPG、HbAlc水平明显比对照组低。治疗后,两组患者血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)水平较治疗前均显著降低,高密度脂蛋白胆固醇(HDL-C)水平显著升高,观察组患者血清TC、TG、LDL-C水平明显低于对照组,HDL-C水平明显高于对照组。在动态血糖参数结果中,两组患者治疗后最大血糖波动幅度(LAGE)、血糖波动系数(SDBG)、平均血糖波动幅度(MAGE)、24h平均血糖水平(24hMBG)较治疗前均显著降低,日平均达标率明显升高。观察组LAGS、SDBG、MAGE、24hMBG水平明显低于对照组,日平均达标率明显比对照组高。结论 :血糖控制不佳的2型糖尿病患者使用利拉鲁肽的降糖效果显著,且无低血糖发生,胃肠道反应少,值得应用推广。
Objective To investigate the clinical efficacy and safety of liraglutide in the treatment of type 2 diabetes mellitus with poor glycemic control. Methods Ninety patients with type 2 diabetes with poor glycemic control who were admitted to our hospital from May 2015 to May 2017 were selected as subjects. According to the random number table method, the patients were divided into observation group(n=45) and control group(n=45). The observation group was treated with liraglutide and the control group was treated with insulin glargine. The changes of blood glucose, blood lipids and 72 h dynamic blood glucose monitoring before and after treatment were compared between the two groups. Results After treatment, the levels of fasting blood glucose(FPG), postprandial blood glucose(2 h PG), glycosylated hemoglobin(HbAlc) in the two groups were lower than those before treatment, while the levels of FPG, 2 h PG and HbAlc in the observation group were significantly lower than those in the control group. After treatment, the levels of serum total cholesterol(TC), triglyceride(TG), low density lipoprotein cholesterol(LDL-C) and high density lipoprotein cholesterol(HDL-C) in the two groups were significantly lower than those before treatment. The levels of serum TC, TG and LDL-C in the observation group were significantly lower than those in the control group,and HDL-C water was significantly higher than that in the control group. The LAGE, SDBG, MAGE and 24 h MBG of the two groups after treatment were significantly lower than those before treatment, and the daily average rate of reaching the standard was significantly higher. The levels of LAGE, SDBG, MAGE and 24 h MBG in the observation group were significantly lower than those in the control group, and the daily average rate of reaching the standard was significantly higher than that in the control group. Conclusion Liraglutide has significant hypoglycemic effect in type 2 diabetes mellitus patients with poor glycemic control, and there is no hypoglycemia and less gastrointestinal reaction, which is worthy of application and promotion.
Objective To investigate the clinical efficacy and safety of liraglutide in the treatment of type 2 diabetes mellitus with poor glycemic control. Methods Ninety patients with type 2 diabetes with poor glycemic control who were admitted to our hospital from May 2015 to May 2017 were selected as subjects. According to the random number table method, the patients were divided into observation group(n=45) and control group(n=45). The observation group was treated with liraglutide and the control group was treated with insulin glargine. The changes of blood glucose, blood lipids and 72 h dynamic blood glucose monitoring before and after treatment were compared between the two groups. Results After treatment, the levels of fasting blood glucose(FPG), postprandial blood glucose(2 h PG), glycosylated hemoglobin(HbAlc) in the two groups were lower than those before treatment, while the levels of FPG, 2 h PG and HbAlc in the observation group were significantly lower than those in the control group. After treatment, the levels of serum total cholesterol(TC), triglyceride(TG), low density lipoprotein cholesterol(LDL-C) and high density lipoprotein cholesterol(HDL-C) in the two groups were significantly lower than those before treatment. The levels of serum TC, TG and LDL-C in the observation group were significantly lower than those in the control group,and HDL-C water was significantly higher than that in the control group. The LAGE, SDBG, MAGE and 24 h MBG of the two groups after treatment were significantly lower than those before treatment, and the daily average rate of reaching the standard was significantly higher. The levels of LAGE, SDBG, MAGE and 24 h MBG in the observation group were significantly lower than those in the control group, and the daily average rate of reaching the standard was significantly higher than that in the control group. Conclusion Liraglutide has significant hypoglycemic effect in type 2 diabetes mellitus patients with poor glycemic control, and there is no hypoglycemia and less gastrointestinal reaction, which is worthy of application and promotion.
引文
[1]叶守姣,张硕,常柏.肥胖与2型糖尿病患者并发症的关系[J].山东医药, 2015, 55(37):41-42.
[2]Kurata M, Takenouchi A, Tsuboi A, et al. The cluster of abnormalities related to metabolic syndrome is associated with reduced glomerular filtration rate and raised albuminuria in patients with type 2 diabetes mellitus[J]. J Clin Med Res, 2017, 9(9):759-764.
[3]嵇加佳,刘林,楼青青,等.2型糖尿病患者自我管理行为及血糖控制现状的研究[J].中华护理杂志, 2014, 49(05):617-620.
[4]Sharma V, Pangtey GS, Gupta R, et al. Correlation of long-term glycemic control as measured by glycated hemoglobin with serum angiopoietin-like 6 protein levels in type 2 diabetes mellitus patients[J]. Indian J Pharmacol, 2017, 49(3):250-253.
[5]Kramer CK, Zinman B, Choi H, et al. Impact of the glucagon assay when assessing the effect of chronic liraglutide therapy on glucagon secretion[J].J Clin Endocrinol Metab, 2017, 102(8):2729-2733.
[6]牛颜丽,吴国富,袁靖.胰岛素治疗的肥胖2型糖尿病患者加用利拉鲁肽的临床疗效研究[J].中国全科医学, 2014, 17(01):56-60.
[7]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中国糖尿病杂志, 2014, 22(08):2-42.
[8]童于真,童南伟.中国成人2型糖尿病预防的专家共识精要[J].中国实用内科杂志, 2014, 34(07):671-677.
[9]Zhang YT, Mujahid MS, Laraia BA, et al. Association between neighborhood supermarket presence and glycated hemoglobin levels among patients with type 2 diabetes mellitus[J]. Am J Epidemiol, 2017, 185(12):1297-1303.
[10]王莉,尚有全,苏伟.2型糖尿病危险因素分析[J].中国医师杂志,2014, 16(05):681-682.
[11] Harris C, Forst T, Heise T, et al. Hypoglycemia risk related to double dose is markedly reduced with basal insulin peglispro versus insulin glargine in patients with type 2 diabetes mellitus in a randomized trial:IMAGINE 8[J]. Diabetes Technol Ther, 2017, 19(8):463-470.
[12]彭望英,况福连.胰岛素联合口服药物治疗初诊2型糖尿病疗效研究[J].江西医药, 2015, 50(03):244-246.
[13]毛培军,李桂玲,黄倩,等.利拉鲁肽联合门冬胰岛素30治疗难治性2型糖尿病的临床疗效及安全性评价[J].中国临床药理学杂志,2015, 31(16):1578-1581.
[14] Rydén A, Chen S, Flood E, et al. Discrete choice experiment attribute selection using a multinational interview study:treatment features important to patients with type 2 diabetes mellitus[J]. Patient, 2017, 10(4):475-487.
[15] Qin L, Chen S, Flood E, et al. Glucagon-like peptide-1 receptor agonist treatment attributes important to injection-experienced patients with type 2 diabetes mellitus:a preference study in germany and the united kingdom[J]. Diabetes Ther, 2017, 8(2):335-353.
[16]姚璐,田国祥,武云涛,等.二甲双胍分别联合利拉鲁肽及甘精胰岛素治疗2型糖尿病的临床观察[J].中国循证心血管医学杂志,2015, 7(01):100-102.
[17] Nuffer WA, Trujillo JM. Liraglutide:A new option for the treatment of obesity[J]. Pharmacotherapy, 2015, 35(10):926-934.
[18]王国凤,尹冬,徐宁,等.血糖波动与糖尿病周围神经病变的相关性[J].中国糖尿病杂志, 2014, 22(02):115-117.
[19]罗维思,颜仁嫦,黎潜.动态血糖监测2型糖尿病患者全天血糖漂移变化的临床意义[J].医学临床研究, 2014, 31(07):1318-1320.
[2]Kurata M, Takenouchi A, Tsuboi A, et al. The cluster of abnormalities related to metabolic syndrome is associated with reduced glomerular filtration rate and raised albuminuria in patients with type 2 diabetes mellitus[J]. J Clin Med Res, 2017, 9(9):759-764.
[3]嵇加佳,刘林,楼青青,等.2型糖尿病患者自我管理行为及血糖控制现状的研究[J].中华护理杂志, 2014, 49(05):617-620.
[4]Sharma V, Pangtey GS, Gupta R, et al. Correlation of long-term glycemic control as measured by glycated hemoglobin with serum angiopoietin-like 6 protein levels in type 2 diabetes mellitus patients[J]. Indian J Pharmacol, 2017, 49(3):250-253.
[5]Kramer CK, Zinman B, Choi H, et al. Impact of the glucagon assay when assessing the effect of chronic liraglutide therapy on glucagon secretion[J].J Clin Endocrinol Metab, 2017, 102(8):2729-2733.
[6]牛颜丽,吴国富,袁靖.胰岛素治疗的肥胖2型糖尿病患者加用利拉鲁肽的临床疗效研究[J].中国全科医学, 2014, 17(01):56-60.
[7]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中国糖尿病杂志, 2014, 22(08):2-42.
[8]童于真,童南伟.中国成人2型糖尿病预防的专家共识精要[J].中国实用内科杂志, 2014, 34(07):671-677.
[9]Zhang YT, Mujahid MS, Laraia BA, et al. Association between neighborhood supermarket presence and glycated hemoglobin levels among patients with type 2 diabetes mellitus[J]. Am J Epidemiol, 2017, 185(12):1297-1303.
[10]王莉,尚有全,苏伟.2型糖尿病危险因素分析[J].中国医师杂志,2014, 16(05):681-682.
[11] Harris C, Forst T, Heise T, et al. Hypoglycemia risk related to double dose is markedly reduced with basal insulin peglispro versus insulin glargine in patients with type 2 diabetes mellitus in a randomized trial:IMAGINE 8[J]. Diabetes Technol Ther, 2017, 19(8):463-470.
[12]彭望英,况福连.胰岛素联合口服药物治疗初诊2型糖尿病疗效研究[J].江西医药, 2015, 50(03):244-246.
[13]毛培军,李桂玲,黄倩,等.利拉鲁肽联合门冬胰岛素30治疗难治性2型糖尿病的临床疗效及安全性评价[J].中国临床药理学杂志,2015, 31(16):1578-1581.
[14] Rydén A, Chen S, Flood E, et al. Discrete choice experiment attribute selection using a multinational interview study:treatment features important to patients with type 2 diabetes mellitus[J]. Patient, 2017, 10(4):475-487.
[15] Qin L, Chen S, Flood E, et al. Glucagon-like peptide-1 receptor agonist treatment attributes important to injection-experienced patients with type 2 diabetes mellitus:a preference study in germany and the united kingdom[J]. Diabetes Ther, 2017, 8(2):335-353.
[16]姚璐,田国祥,武云涛,等.二甲双胍分别联合利拉鲁肽及甘精胰岛素治疗2型糖尿病的临床观察[J].中国循证心血管医学杂志,2015, 7(01):100-102.
[17] Nuffer WA, Trujillo JM. Liraglutide:A new option for the treatment of obesity[J]. Pharmacotherapy, 2015, 35(10):926-934.
[18]王国凤,尹冬,徐宁,等.血糖波动与糖尿病周围神经病变的相关性[J].中国糖尿病杂志, 2014, 22(02):115-117.
[19]罗维思,颜仁嫦,黎潜.动态血糖监测2型糖尿病患者全天血糖漂移变化的临床意义[J].医学临床研究, 2014, 31(07):1318-1320.