西格列汀单药治疗对不同病程2型糖尿病患者血糖的影响
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摘要
目的:观察二肽酶抑制剂西格列汀单药治疗对不同病程2型糖尿病的疗效。方法:选择符合条件的未经药物治疗的病程1年之内的2型糖尿病患者为A组(n=12),病程3～4年的2型糖尿病患者为B组(n=12)。两组行口服糖耐量试验、胰岛素释放试验、活性胰高血糖素样肽-1(GLP-1)浓度及糖化血红蛋白(Hb A1C)测定,然后给予口服西格列汀100 mg,每日1次,12周后复查上述指标,比较血糖、HbA1C、胰岛β细胞功能、活性GLP-1变化。结果:A组患者治疗后空腹血糖(FBG)下降约26. 4%、餐后2 h血糖(PG2h)下降约31%、HbA1C下降约1. 8%、活性GLP-1水平增高、胰岛β细胞功能明显改善(P <0. 05); B组患者治疗后FBG下降约9%、PG2h下降约22. 7%、HbA1C下降约1. 2%、活性GLP-1水平增高(P <0. 05),胰岛β细胞功能轻度改善(P> 0. 05)。西格列汀治疗后A组的FBG,PG2h,HbA1C的下降幅度明显大于B组,两组比较,差异有统计学意义(P <0. 05); A组胰岛β细胞功能、活性GLP-1水平改善幅度大于B组,两组比较,差异有统计学意义(P <0. 05)。结论:西格列汀单药治疗后,病程≤1年及病程3～4年的2型糖尿病患者HbA1C均有明显下降;病程≤1年的患者FBG、PG2h、HbA1C降低幅度大于病程3～4年患者;病程≤1年患者胰岛β细胞的改善、活性GLP-1水平增高幅度大于病程3～4年患者。
Objective: To study whether the effect of monotherapy of sitagliptin is related to diabetes duration. Methods:Patients with type 2 diabetes ≤ 1 year duration( group A,n = 12) and 3 ～ 4 years duration( group B,n = 12) were studied. All patients had no history of anti-hyperglycemic therapy and were treated with lifestyle intervention only. A oral glucose tolerance test,insulin releasing test,glycosylated hemoglobin A1C( HbA1c),blood lipids,and bioactive glucagon-like peptide-1( GLP-1) were measured at the baseline and after sitagliptin treatment for 12 weeks. Results: For patients in group A,the area under the curve( AUC) of GLP-1 increased significantly,fasting plasma glucose( FBG) decreased by approximately 26. 4%,2 h postprandial plasma glucose( PG2 h) decreased by approximately 31%,HbA1C decreased by approximately 1. 8%,AUC of GLP-1 increased,β cell function obviously improved( all P < 0. 05). For patients in group B,FPG decreased by approximately 9%,PG2 h decreased by approximately 22. 7%( all P < 0. 05),HbA1C decreased by approximately 1. 2%( P < 0. 05),AUC-bio-GLP-1 increased( P < 0. 05),and β cell function improved slightly( P > 0. 05). The degree of FPG,PG2 h and HbA1C decrease in group A was more than that in group B( all P < 0. 05),and β cell function improved and AUC-bio-GLP-1 increased significantly in group A( all P < 0. 05). Conclusions: Monotherapy of sitagliptin is effective to lower HbA1C in groups A and B. The degree of FPG,PG2 h,and HbA1C decrease,and the magnitude of β cell function and bio-GLP-1 improvement was greater in group A.
Objective: To study whether the effect of monotherapy of sitagliptin is related to diabetes duration. Methods:Patients with type 2 diabetes ≤ 1 year duration( group A,n = 12) and 3 ～ 4 years duration( group B,n = 12) were studied. All patients had no history of anti-hyperglycemic therapy and were treated with lifestyle intervention only. A oral glucose tolerance test,insulin releasing test,glycosylated hemoglobin A1C( HbA1c),blood lipids,and bioactive glucagon-like peptide-1( GLP-1) were measured at the baseline and after sitagliptin treatment for 12 weeks. Results: For patients in group A,the area under the curve( AUC) of GLP-1 increased significantly,fasting plasma glucose( FBG) decreased by approximately 26. 4%,2 h postprandial plasma glucose( PG2 h) decreased by approximately 31%,HbA1C decreased by approximately 1. 8%,AUC of GLP-1 increased,β cell function obviously improved( all P < 0. 05). For patients in group B,FPG decreased by approximately 9%,PG2 h decreased by approximately 22. 7%( all P < 0. 05),HbA1C decreased by approximately 1. 2%( P < 0. 05),AUC-bio-GLP-1 increased( P < 0. 05),and β cell function improved slightly( P > 0. 05). The degree of FPG,PG2 h and HbA1C decrease in group A was more than that in group B( all P < 0. 05),and β cell function improved and AUC-bio-GLP-1 increased significantly in group A( all P < 0. 05). Conclusions: Monotherapy of sitagliptin is effective to lower HbA1C in groups A and B. The degree of FPG,PG2 h,and HbA1C decrease,and the magnitude of β cell function and bio-GLP-1 improvement was greater in group A.
引文
[1]HOLST J J,VILSBLL T,DEACON C F.The incretin system and its role in type 2 diabetes mellitus[J].Mol Cell Endocrinol,2009,297(1-2):127-136.
[2]TOFT-NIELSEN M B,DAMHOLT M B,MADSBAD S,et al.Determinants of the impaired secretion of glucagon-like peptide-1 in type 2 diabetic patients[J].J Clin Endocrinol Metab,2001,86(8):3717-3723.
[3]U.K.prospective diabetes study 16.Overview of 6 years'therapy of typeⅡdiabetes:a progressive disease.U.K.Prospective Diabetes Study Group[J].Diabetes,1995,44(11):1 249-1 258.
[4]KAHN S E,HAFFNER S M,HEISE M A,et al.ADOPTStudy Group.Glycemic durability of rosiglitazone,metformin,or glyburide monotherapy[J].N Engl J Med,2006,355(23):2427-2443.
[5]SOLIS-HERRERA C,TRIPLITT C,GARDUNO-GAR-CIA JDE J,et al.Mechanisms of glucose lowering of dipeptidyl peptidase-4 inhibitor sitagliptin when used alone or with metformin in type 2 diabetes:a double-tracer study[J].Diabetes Care,2013,36(9):2756-2762.
[6]邵聪,吕肖峰,肖新华,等.天麦消渴片治疗中国新诊断2型糖尿病患者的疗效研究[J].中华医学杂志,2012,92(22):1522-1526.
[7]ASCHNER P,KIPNES M S,LUNCEFORD J K,et al.Effect of the dipeptidyl peptidase-4 inhibitor sitagliptin as monotherapy on glycemic control in patients with type2 diabetes[J].Diabetes Care,2006,29:2632-2637.
[8]YANG W,GUAN Y,SHENTU Y,et al.The addition of sitagliptin to ongoing metformin therapy significantly improves glycemic control in Chinese patients with type 2diabetes[J].J Diabetes,2012,4(3):227-237.
[2]TOFT-NIELSEN M B,DAMHOLT M B,MADSBAD S,et al.Determinants of the impaired secretion of glucagon-like peptide-1 in type 2 diabetic patients[J].J Clin Endocrinol Metab,2001,86(8):3717-3723.
[3]U.K.prospective diabetes study 16.Overview of 6 years'therapy of typeⅡdiabetes:a progressive disease.U.K.Prospective Diabetes Study Group[J].Diabetes,1995,44(11):1 249-1 258.
[4]KAHN S E,HAFFNER S M,HEISE M A,et al.ADOPTStudy Group.Glycemic durability of rosiglitazone,metformin,or glyburide monotherapy[J].N Engl J Med,2006,355(23):2427-2443.
[5]SOLIS-HERRERA C,TRIPLITT C,GARDUNO-GAR-CIA JDE J,et al.Mechanisms of glucose lowering of dipeptidyl peptidase-4 inhibitor sitagliptin when used alone or with metformin in type 2 diabetes:a double-tracer study[J].Diabetes Care,2013,36(9):2756-2762.
[6]邵聪,吕肖峰,肖新华,等.天麦消渴片治疗中国新诊断2型糖尿病患者的疗效研究[J].中华医学杂志,2012,92(22):1522-1526.
[7]ASCHNER P,KIPNES M S,LUNCEFORD J K,et al.Effect of the dipeptidyl peptidase-4 inhibitor sitagliptin as monotherapy on glycemic control in patients with type2 diabetes[J].Diabetes Care,2006,29:2632-2637.
[8]YANG W,GUAN Y,SHENTU Y,et al.The addition of sitagliptin to ongoing metformin therapy significantly improves glycemic control in Chinese patients with type 2diabetes[J].J Diabetes,2012,4(3):227-237.