[1]李静 李楠 杨永歆.2型糖尿病患者胰岛素治疗加用达格列净的 疗效及安全性[J].国际内分泌代谢杂志,2018,38(05):289-292.[doi:10.3760/cma.j.issn.1673-4157.2018.05.001]
　Li Jing*,Li Nan,Yang Yongxin.The efficacy and safety of dapagliflozin in patients with type 2 diabetes receiving insulin therapy[J].International Journal of Endocrinology and Metabolism,2018,38(05):289-292.[doi:10.3760/cma.j.issn.1673-4157.2018.05.001]
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2型糖尿病患者胰岛素治疗加用达格列净的 疗效及安全性()
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《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
38
期数:
2018年05期
页码:
289-292
栏目:
论著
出版日期:
2018-09-20

文章信息/Info

Title:
The efficacy and safety of dapagliflozin in patients with type 2 diabetes receiving insulin therapy
作者:
李静 李楠 杨永歆
作者单位:300150 天津市第二医院内分泌科(李静、杨永歆); 100853 北京,解放军总医院南楼老年内分泌科(李楠)
Author(s):
Li Jing*;  Li Nan;  Yang Yongxin
*Department of Endocrinology, The Second Hospital of Tianjin City, Tianjin 300150, China
关键词:
2型糖尿病;  达格列净;  钠-葡萄糖协同转运蛋白2抑制剂
Keywords:
Type 2 diabetes mellitus;  Dapagliflozin;  Sodium-glucose cotransporter 2 inhibitor
DOI:
10.3760/cma.j.issn.1673-4157.2018.05.001
摘要:
目的 评价胰岛素治疗基础上加用达格列净的疗效及安全性。方法 选取天津市第二医院内分泌科2017年8-12月住院的应用较大剂量胰岛素但血糖控制欠佳的2型糖尿病患者45例为研究对象,根据随机数字表法分为联合组(n=23)和胰岛素组(n=22)。联合组减少胰岛素日总量的 50%后加用达格列净 10 mg,胰岛素组根据病情及血糖情况调整胰岛素剂量及注射次数,所有患者保留其原治疗方案的口服药物剂量不变。观察治疗12周后两组的HbA1c、空腹血糖、餐后血糖、体重、24 h尿量、24 h尿微量白蛋白、血压、低密度脂蛋白-胆固醇(LDL-C)变化,比较两组间低血糖发生次数,泌尿系统感染人数等不良反应。结果 治疗后,联合组、胰岛素组空腹血糖、餐后血糖、HbA1c均较基线下降(t'=6.448～11.360,P均<0.01)。与胰岛素组相比,联合组空腹血糖、餐后血糖、HbA1c下降更明显(t=7.691、5.200、5.218,P均<0.01); 联合组在治疗12周后体重、收缩压、舒张压均下降(t'=11.884、5.970、4.700, P均<0.01),LDL-C升高、24 h尿量增加(t'=9.167、12.092, P均<0.01),24 h尿微量白蛋白无明显变化(P>0.05)。联合组低血糖次数少于胰岛素组(χ2=5.847,P<0.05),两组发生低血糖人数相当(P>0.05); 联合组出现1例泌尿系统感染,两组泌尿系统感染发生率差异无统计学意义(P>0.05)。结论 2型糖尿病患者应用较大剂量胰岛素仍不能使血糖达标的情况下,加用达格列净治疗效果优于胰岛素治疗,且不增加低血糖发生风险。
Abstract:
Objective To evaluate the efficacy and safety of adding dapagliflozin to insulin therapy in type 2 diabetic patients.Methods A total of 45 hospitalized patients who were uncontrolled by high dose of insulin in the Department of Endocrinology, the Second Hospital of Tianjin City between August and December in 2017 were assigned to combined group(n=23)and insulin group(n=22)according to random number table. Patients in combined group began 10 mg dapagliflozin treatment on the basis of their original oral antidiabetic agents but decreased their original daily insulin dosage by 50%. Patients in insulin group maintained their stable dose of oral antidiabetic agents but adjusted their insulin therapy by frequency and dosage according to the condition and blood glucose level. HbA1c, fasting plasma glucose(FPG), postprandial glucose(PPG), body weight, 24-h urine volume, 24-h urinary microalbumin, blood pressure and blood low density lipoprotein-cholesterol(LDL-C)after 12 weeks were analyzed, and adverse events including hypoglycemia and urinary infection were recorded.Results The FPG, PPG and HbA1c levels were significantly decreased from baseline in combined group and insulin group(t'=6.448-11.360, all P<0.01). Compared with insulin group, the FPG, PPG, HbA1c levels were lower in combined group(t=7.691, 5.200, 5.218, all P<0.01). The body weight, systolic and diastolic blood pressure were decreased(t'=11.884, 5.970, 4.700, all P<0.01), while the LDL-C level and 24-h urine volume were increased(t'=9.167, 12.092, all P<0.01)in combined group after treatment for 12 weeks. There was no significant difference in 24-h urinary microalbumin in combined group(P>0.05). There was fewer hypoglycemia events in combined group than that in insulin group(χ2=5.847, P<0.05), while the number of patients experienced hypoglycemia was not different between the two groups(P>0.05). One patient in combined group experienced urinary tract infection, while there was no statistic difference in the incidence of urinary tract infection between the two groups(P>0.05). Conclusion In patients with uncontrolled type 2 diabetes by high dose insulin, dapagliflozin is superior in glycemic control than insulin treatment without increasing the risk of hypoglycemia.

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备注/Memo

备注/Memo:
作者单位:300150 天津市第二医院内分泌科(李静、杨永歆); 100853 北京,解放军总医院南楼老年内分泌科(李楠)
通信作者:李楠,Email:wsln_may07@163.com
更新日期/Last Update: 2018-09-30