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目的研究甘精胰岛素联合格列美脲及阿卡波糖治疗发生磺脲类治疗失效(SFS)的T2DM患者的临床效果。方法选取SFS的T2DM患者48例,采用甘精胰岛素联合格列美脲及阿卡波糖治疗方案,持续3个月,对比治疗前后的血糖及相关指标变化情况。结果经3个月治疗后,TG、TC、LDL-C较治疗前降低,HDL-C较治疗前提高,但比较差异无统计学意义(P>0.05);FPG[(11.2±1.8)vs(5.4±1.2)mmol/L]、2 hPG[(16.7±5.5)vs(8.7±3.6)mmol/L]、24 h最高血糖值[(20.1±3.5)vs(10.2土2.4)mmol/L]、平均血糖值[(15.6±3.3)vs(6.5±1.3)mmol/L]、HbA_1 c[(10.9±1.3)%vs(7.6±0.8)%]、胰岛素抵抗指数(HOMA-IR)[(13.06±6.35)vs(9.02±3.16)]均较治疗前降低(P<0.05),FC-P[(2.04±0.16)vs(2.29±0.20)ng/ml]、2 hC-P[(3.59±0.61)vs(4.13±0.72)ng/ml]、胰岛β细胞功能指数(HOMA-β)[(142.64±26.95)vs(178.86±33.92)]均较治疗前提高(P<0.05);24 h血糖达标维持时间长于治疗前[(19.2±-3.7)vs(2.5±1.6)h](P<0.05)。结论甘精胰岛素联合格列美脲及阿卡波糖治疗SFS的T2DM患者能有效控制血糖,患者24 h血糖控制效果更佳。
Objective To investigate the clinical effects of glargine combined with glimepiride and acarbose in the treatment of T2DM patients with sulfonylurea failure (SFS). Methods Forty-eight T2DM patients with SFS were treated with insulin glargine and glimepiride and acarbose for 3 months. The changes of blood glucose and related indexes before and after treatment were compared. Results After 3 months of treatment, TG, TC, LDL-C decreased compared with before treatment, HDL-C increased compared with before treatment, but the difference was not statistically significant (P> 0.05); FPG [(11.2 ± 1.8) vs 5.4 ± 1.2 mmol / L], 2 hPG [(16.7 ± 5.5) vs (8.7 ± 3.6) mmol / L], 24 h maximum blood glucose value [(20.1 ± 3.5) vs Mean blood glucose (HbA 1 c [(10.9 ± 1.3) vs (7.6 ± 0.8)%], insulin resistance index (HOMA-IR) (P <0.05), FC-P (2.04 ± 0.16) vs (2.29 ± 0.20) ng / ml], 2 hC-P [(3.59 ± 0.61) vs (4.13 ± 0.72) ng / ml], and HOMA-β [(142.64 ± 26.95) vs (178.86 ± 33.92)] were significantly higher than those before treatment (P <0.05) Longer than before treatment [(19.2 ± 3.7 vs 2.5 ± 1.6) h] (P <0.05). Conclusion Glargine combined with glimepiride and acarbose treatment of T2DM in patients with SFS can effectively control blood glucose, blood glucose control in patients with better effect 24 h.