目的 探討甘精胰島素聯(lián)合阿卡波糖對(duì)2型糖尿病患者胰島功能的影響及可能的機(jī)制。方法 82例2型糖尿病患者隨機(jī)分為治療組和對(duì)照組,每組41例。對(duì)照組口服阿卡波糖片,起始劑量50 mg/次,3次/d,并于每日3餐主食前sc普通胰島素,起始劑量1次0.1~0.15 U/kg;治療組在對(duì)照組基礎(chǔ)上將普通胰島素改為甘精胰島素,睡前sc甘精胰島素1次/d,起始劑量為0.2 U/kg,均連續(xù)用藥12周。比較兩組治療前后胰島素抵抗指數(shù)(Homa-IR)、胰島素分泌指數(shù)(Homa-β)、超氧化物歧化酶(SOD)、丙二醛(MDA)、白介素-6(IL-6),以及血糖控制情況。結(jié)果 治療前兩組Homa-IR、Homa-β、SOD、MDA和IL-6無顯著性差異;治療后兩組Homa-β和SOD均顯著升高,而Homa-IR、MDA和IL-6顯著減低(P < 0.05,0.01),治療組的Homa-β和SOD顯著高于對(duì)照組,Homa-IR、MDA和IL-6顯著低于對(duì)照組(P < 0.05)。治療組血糖達(dá)標(biāo)時(shí)間平均為(6.91±1.26)d,低血糖次數(shù)平均為(0.42±0.09)次,均顯著低于對(duì)照組的(9.76±1.84)d、(1.16±0.32)次(P < 0.05,0.01)。結(jié)論 甘精胰島素聯(lián)合阿卡波糖可顯著改善2型糖尿病患者氧化應(yīng)激狀態(tài),提高對(duì)胰島素的敏感性,改善胰島功能,低血糖不良反應(yīng)發(fā)生低,能快速、安全、有效地控制血糖。

Objective To detect the effect of glargine insulin combined with acarbose on islet function in patients with type 2 diabetes mellitus (T2DM) and explore its mechanisms and clinical safety. Methods A total of 82 T2DM patients were enrolled in this study. Patients were randomly divided into control group (n=41) and treatment group (n=41). Acarbose (50 mg/time, 3 times/d) and insulin (0.1-0.15 U/kg) was given in control group for 12 weeks. Acarbose (50 mg/time, 3 times/d) and glargine insulin (0.2 U/kg) were given in observation group for 12 weeks. The Homa-IR, Homa-β, SOD, MDA, IL-6, and blood glucose control were compared. Results Before treatment, There was no significant difference of Homa-IR, Homa-β, SOD, MDA, and IL-6 between the two groups. After treatment, the Homa-β and SOD in observation group were higher than those in control group (P < 0.05), and the Homa-IR, MDA, and IL-6 in observation group were lower than those in control group (P < 0.05). The blood glucose standard time, hypoglycemia number, and insulin dosage were (6.91±1.26) d, (0.42±0.09) times in observation group, which were significantly lower than that of (9.76±1.84) d, (1.16±0.32) times in control group (P < 0.05,0.01). Conclusion Glargine insulin combined with acarbose can significantly improve the oxidative stress, sensitivity of patients to insulin, and islet function in T2DM patients, with low incidence of hypoglycemia, which can fast, safely and effectively control blood glucose in T2DM patients.