以单方二甲双胍治疗的2型糖尿病患者的血糖
论著/OriginalArticle
JournalofDiabetes9()-
以单方二甲双胍治疗的2型糖尿病患者的血糖波动与阿卡波糖治疗后的糖化血红蛋白下降呈正相关
GlycemicexcursionswerepositivelyassociatedwithHbA1creductionfrombaselineaftertreatmentwithacarboseinpatientswithtype2diabetesonmetforminmonotherapy
Jun-SingWANG,1,7I-TeLEE,1,4,8Wen-JaneLEE,2Shi-DouLIN,6Shih-LiSU,6Shih-TeTU,6Yao-HsienTSENG,1Shih-YiLIN1,3,8andWayneHuey-HerngSHEU1,5,8,9
1DivisionofEndocrinologyandMetabolism,DepartmentofInternalMedicine,2DepartmentofMedicalResearch,3CenterofGeriatricsandGerontology,TaichungVeteransGeneralHospital,4DepartmentofMedicine,SchoolofMedicine,ChungShanMedicalUniversity,5InstituteofMedicalTechnology,CollegeofLifeScience,NationalChung-HsingUniversity,Taichung,6DivisionofEndocrinologyandMetabolism,DepartmentofInternalMedicine,Chang-HuaChristianHospital,Chang-Hua,7InstituteofClinicalMedicine,8DepartmentofMedicine,SchoolofMedicine,NationalYang-MingUniversity,and9SchoolofMedicine,NationalDefenseMedicalCenter,Taipei,Taiwan
摘要
背景:本研究的目的是检视2型糖尿病患者治疗前的血糖波动和使用阿卡波糖或格列本脲强化治疗后糖化血红蛋白下降之间的相关性。
方法:使用1至2种口服降糖药物，且糖化血红蛋白介于7%-11%（53-97mmol/mol）之间的2型糖尿病患，先转换至单方二甲双胍（mg每天3次）治疗8周，接着随机分组以阿卡波糖（mg每天3次）或格列本脲（5mg每天3次）强化治疗16周。以72小时连续血糖监测计算的平均血糖波动幅度（meanamplitudeofglycemicexcursions，MAGE）评估血糖波动。治疗效果则以相对糖化血红蛋白降幅（%）来评估（[基线糖化血红蛋白-治疗后糖化血红蛋白]×%/基线糖化血红蛋白）。
结果:一共分析了50位患者（平均年龄53.5±8.2岁，48%为男性，平均基线糖化血红蛋白为8.4%±1.2%）。基线MAGE与阿卡波糖治疗后的相对糖化血红蛋白降幅呈显著正相关（r=0.，P=0.），但与格列本脲治疗后的相对糖化血红蛋白降幅无显著相关性（r=0.，P=0.）。以线性回归分析，校正干扰因子之后，基线MAGE与阿卡波糖治疗后的相对糖化血红蛋白降幅之间的相关性依然显著（β=0.，P=0.）（所有模型P0.05）。
结论:在以单方二甲双胍治疗的2型糖尿病患者，基线MAGE与阿卡波糖的治疗效果呈显著正相关，但与格列本脲的治疗效果无显著相关性。这些发现显示了血糖波动对于2型糖尿病患者个体化治疗的重要性。
关键词:阿卡波糖，连续血糖监测，血糖波动，糖化血红蛋白，2型糖尿病
Background
TheaimofthepresentstudywastoexaminetheassociationbetweenglycemicexcursionsbeforetreatmentandHbA1creductionaftertreatmentintensificationwithacarboseorglibenclamideinpatientswithtype2diabetes(T2D).
Methods
PatientsreceivingsingleordualoralantidiabeticdrugtreatmentwithanHbA1cof7.0–11.0%(53–97?mmol/mol)wereswitchedtometforminmonotherapy(?mg,t.i.d.)for8?weeks,followedbyrandomizationtoeitheracarbose(?mg,t.i.d.)orglibenclamide(5?mg,t.i.d.)asadd-ontreatmentfor16?weeks.Glycemicexcursionswereassessedasmeanamplitudeofglycemicexcursions(MAGE)with72-hambulatorycontinuousglucosemonitoring.TreatmentefficacywasevaluatedasrelativeHbA1creduction(%),calculatedas(baselineHbA1c–post-treatmentHbA1c)/baselineHbA1c?×?.
Results
Fiftypatients(mean[±SD]age53.5?±?8.2?years,48%men,meanbaselineHbA1c8.4?±?1.2%)wereanalyzed.BaselineMAGEwaspositivelycorrelatedwithrelativeHbA1creductionfrombaselineinpatientstreatedwithacarbose(r?=?0.,P?=?0.)butnotglibenclamide(r?=?0.,P?=?0.).LinearregressionanalysisrevealedthattheassociationbetweenbaselineMAGEandrelativeHbA1creductionfrombaseline(β?=?0.,P?=?0.)inpatientstreatedwithacarboseremainedsignificantafteradjustmentforseveralconfounders(P?0.05forallmodels).
Conclusions
InpatientswithT2Donmetforminmonotherapy,baselineMAGEwaspositivelycorrelatedwithrelativeHbA1creductionfrombaselineaftertreatmentwithacarbose,butnotglibenclamide.ThesefindingshighlighttheimportanceofglycemicexcursionsinindividualizedtreatmentforpatientswithT2D.
亿糖网：yitangwang
JournalofDiabetes（主编：宁光（中国），ZacharyT.Bloomgarden（美国））主办，记录糖尿病临床研究的足迹，推进中国逾亿位糖尿病患者的诊治！
