Abstract:

To study the effects of glimepiride combined with metformin and rhythmic exercise on islet function and cardiovascular risk in patients with type 2 diabetes mellitus. Methods　A total of 99 patients with type 2 diabetes mellitus treated in Jinan Second People's Hospital from January 2020 to February 2023 were selected and were divided into a control group and an observation group according to the coin toss method. In the control group, 50 patients were treated with metformin combined with rhythmic exercise, including 31 males and 19 females, aged (61.25±2.64) years. In the observation group, 49 patients were treated with glimepiride combined with metformin and rhythmic exercise, including 30 males and 19 females, aged (61.31±2.60) years. The therapeutic effect, islet function, inflammatory factors, blood lipid indexes, and occurrence of adverse reactions were compared between the two groups. t test and χ² test were used. Results　After treatment, the levels of fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), fasting insulin (FINS), and postprandial 2 h blood glucose (2hPG) were decreased in the two groups and the four indexes of the observation group [FPG (6.68±1.21) mmol/L, HbA1c (7.10±0.95) %, FINS (7.68±2.57) μU/ml, and 2hPG (7.34±1.14) mmol/L] were lower than those of the control group [FPG (7.25±1.26) mmol/L, HbA1c (7.71±1.03) %, FINS (8.94±2.96) μU/ml, and 2hPG (8.04±1.23) mmol/L] (all P<0.05). After treatment, the insulin resistance index (HOMA-IR) was decreased in the two groups, and that in the observation group was lower than that in the control group [(2.15±0.39) vs. (2.39±0.40)] (all P<0.05). The insulin sensitivity indexes (ISI) and islet β cell function indexes (HOMA-β) of the two groups after treatment were higher than those before treatment, and those in the observation group [HOMA-β (47.63±2.75) and ISI (2.95±0.43)] were higher than those in the control group [HOMA-β (45.91±2.61) and ISI (2.64±0.47)] (all P<0.05). After treatment, the levels of interleukin-1β (IL-1β), C-reactive protein (CRP), and tumor necrosis factor (TNF) -α were decreased in the two groups, and the levels of IL-1β [(4.86±1.02) ng/L], CRP [(1.34±0.03) mg/L], TNF-α [(8.62±1.36) ng/L] in the observation group were lower than those in the control group [IL-1β (5.48±1.23) ng/L, CRP (1.39±0.04) mg/L, and TNF-α (9.54±1.59) ng/L] (all P<0.05). After treatment, the levels of triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and total cholesterol (TC) were decreased in the two groups, and the levels of TG [(4.17±1.18) mmol/L], TC [(2.28±0.95) mmol/L], LDL-C [(2.50±0.29) mmol/L] in the observation group were lower than those in the control group [TG (4.73±1.02) mmol/L, TC (2.89±1.13) mmol/L, and LDL-C (2.69±0.32) mmol/L] (all P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the observation group [14.29% (7/49)] and the control group [10.00% (5/50)] (χ²=0.427, P=0.514). Conclusion　The combination of glimepiride, metformin, and arrhythmic exercise for type 2 diabetes mellitus has better hypoglycemic effect, which can significantly improve the islet function and blood lipid level, with lower inflammatory response and fewer adverse cardiovascular reactions.

Key words:

Type  , 2  , diabetes  , mellitus, Glimepiride, Metformin, Rhythmic exercise, Islet function, Inflammatory status, Cardiovascular risk,  , Fasting insulin, Lipid indexes

摘要：

目的　研究格列美脲联合二甲双胍和节律运动干预对2型糖尿病患者胰岛功能、心血管危险的影响。方法　选取2020年1月至2023年2月来济南市第二人民医院治疗的99例2型糖尿病患者，依据掷硬币法分为对照组和观察组。对照组50例采用二甲双胍结合节律运动治疗，男31例，女19例，年龄（61.25±2.64）岁；观察组49例采用格列美脲联合二甲双胍和节律运动治疗，男30例，女19例，年龄（61.31±2.60）岁。比较两组患者治疗效果、胰岛功能、炎症因子、血脂指标及不良反应发生情况。采用t检验、χ²检验。结果　两组治疗后空腹血糖（FPG）、糖化血红蛋白（HbA1c）、空腹胰岛素（FINS）及餐后2 h血糖（2hPG）降低且治疗后观察组四项指标［FPG（6.68±1.21）mmol/L、HbA1c（7.10±0.95）%、FINS（7.68±2.57）μU/ml、2hPG（7.34±1.14）mmol/L］均低于对照组［FPG（7.25±1.26）mmol/L、HbA1c（7.71±1.03）%、FINS（8.94±2.96）μU/ml、2hPG（8.04±1.23）mmol/L］（均P<0.05）。治疗后两组胰岛素抵抗指数（HOMA-IR）降低，且观察组低于对照组患者［（2.15±0.39）比（2.39±0.40）］（均P<0.05）；治疗后两组胰岛素敏感指数（ISI）及胰岛β细胞功能指数（HOMA-β）比治疗前上升，且治疗后观察组［HOMA-β（47.63±2.75）、ISI（2.95±0.43）］高于对照组［HOMA-β（45.91±2.61）、ISI（2.64±0.47）］（均P<0.05）。治疗后两组白细胞介素-1β（IL-1β）、C反应蛋白（CRP）及肿瘤坏死因子（TNF）-α 3个炎症因子水平比治疗前降低且治疗后观察组［IL-1β（4.86±1.02）ng/L、CRP（1.34±0.03）mg/L、TNF-α（8.62±1.36）ng/L］低于对照组［IL-1β（5.48±1.23）ng/L、CRP（1.39±0.04）mg/L、TNF-α（9.54±1.59）ng/L］（均P<0.05）。治疗后两组甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）及总胆固醇（TC）水平较治疗前下降，且观察组患者［TG（4.17±1.18）mmol/L、TC（2.28±0.95）mmol/L、LDL-C（2.50±0.29）mmol/L］低于对照组［TG（4.73±1.02）mmol/L、TC（2.89±1.13）mmol/L、LDL-C（2.69±0.32）mmol/L］（均P<0.05）。观察组不良反应总发生率［14.29%（7/49）］与对照组［10.00%（5/50）］比较，差异无统计学意义（χ²=0.427，P=0.514）。结论　格列美脲联合二甲双胍和节律运动治疗2型糖尿病，降糖效果更好，能明显改善患者的胰岛功能、血脂水平，患者炎症反应更低，心血管不良反应少。

关键词:

2型糖尿病, 格列美脲, 二甲双胍, 节律运动, 胰岛功能, 炎症状态, 心血管危险, 空腹胰岛素, 血脂指标