Abstract:

Objective　To explore the value of insulin secretion curve and blood glucose spectrum in the selection of insulin secretagogues for type 2 diabetes, and to provide a basis for clinical selection of insulin secretagogues. Methods　One hundred and twenty patients with type 2 diabetes who selected insulin secretagogues according to the need of hypoglycemic treatment at Dongying Second People's Hospital were selected for the randomized controlled trial. They were divided into an observation group and a control group by the random number table method, with 60 cases in each group. There were 38 males and 22 females in the observation group; they were (58.27±6.34) years old, with a course of disease of (3.62±1.28) years. There were 33 males and 27 females in the control group; they were (59.04±7.82) years old, with a course of disease of (3.55±1.17) years. The observation group carried out the Mantou meal test and selected the insulin secretagogues sulfonylurea (glimepiride and gliclazide) and glinide (repaglinide) according to the insulin secretion curve. The control group selected the insulin secretagogues according to the blood glucose spectrum. Both groups were treated for 24 weeks. The average days of blood glucose control reaching the standard, the rate of blood glucose reaching the standard, the days of hospitalization, and the incidences of hypoglycemia in the two groups were recorded. The insulin β cell function [fasting insulin (FINS), insulin resistance index (HOMA-IR), and C-peptide (CP)] and blood glucose levels [fasting blood glucose (FPG), 2 h postprandial blood glucose (2 h PBG), and glycosylated hemoglobin (HbA1c)] before and after the treatment were compared between the two groups. t and χ² tests were applied. Results　The average days of blood glucose control reaching the standard and hospitalization days in the observation group were shorter than those in the control group [(7.05±1.42) d vs. (8.39±1.86) d and (10.29±2.08) d vs. (11.35±2.17) d]; the rate of blood glucose reaching the standard in the observation group was higher than that in the control group [86.67% (52/60) vs. 71.67% (43/60)]; there were statistical differences (t=4.436, 2.732, χ²=4.093; all P<0.05). After the treatment, the levels of FINS and CP in the observation group were higher than those in the control group [9.32±1.55) IU/L vs. (8.46±1.38) IU/L and (1.49±0.39) μg/L vs. (1.35±0.32) μg/L]; the HOMA-IR in the observation group was lower than that in the control group [(1.92±0.43) vs. (2.37±0.84)]; there were statistical differences (t=3.210, 2.150, and 3.694; all P<0.05). After the treatment, the levels of FPG, 2 h PBG, and HbA1c in the observation group were lower than those in the control group [(6.47±1.12) mmol/L vs. (7.35±0.94) mmol/L, (10.52±1.17) mmol/L vs. (11.83±1.59) mmol/L, and (6.12±1.09)% vs. (6.79±1.35)%], with statistical differences (t=4.662, 5.140, and 2.991; all P<0.05). There was no statistical difference in the incidence of adverse reactions between the observation group and the control group [15.00 (9/60) vs. 18.33 (11/60); χ²=0.240; P=0.624]. Conclusion　Compared with by the blood glucose spectrum, the insulin secretagogue selected by the insulin secretion curve has better insulin secretion promoting and hypoglycemic effects, and is conducive to shortening the time of blood glucose control reaching the standard and hospitalization and improving the rate of blood glucose reaching the standard.

Key words:

Type 2 diabetes, Insulin secretion curve, Blood glucose spectrum, Curative effect

摘要：

目的　探究胰岛素分泌曲线和血糖谱在2型糖尿病选择胰岛素促泌剂中的价值,为临床胰岛素促泌剂选择提供依据。方法　本研究为随机对照试验，选取2015年12月至2020年12月东营市第二人民医院根据降糖治疗需要选用胰岛素促泌剂的2型糖尿病患者120例作为研究对象，采用随机数字表法分为观察组和对照组，各60例。观察组男38例、女22例，年龄（58.27±6.34）岁，病程（3.62±1.28）年；对照组男33例、女27例，年龄（59.04±7.82）岁，病程（3.55±1.17）年。观察组进行馒头餐试验并依据胰岛素分泌曲线选择胰岛素促泌剂；对照组依据血糖谱选择胰岛素促泌剂，两组均治疗24周。对比两组患者血糖控制达标平均天数、血糖达标率、住院天数、低血糖发生率及治疗前后胰岛素β细胞功能[空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IR）、C肽（CP）水平]、血糖[空腹血糖（FPG）、餐后2 h血糖（2 h PBG）、糖化血红蛋白（HbA1c）]水平、不良反应发生情况。采用t检验、χ²检验。结果　观察组血糖控制达标平均天数、住院天数均短于对照组[（7.05±1.42）d比（8.39±1.86）d、（10.29±2.08）d比（11.35±2.17）d]，血糖达标率高于对照组[86.67%（52/60）比71.67%（43/60）]，差异均有统计学意义（t=4.436、2.732，χ²=4.093；均P<0.05）。治疗后，观察组FINS、CP水平均高于对照组[（9.32±1.55）IU/L比（8.46±1.38）IU/L、（1.49±0.39）μg/L比（1.35±0.32）μg/L]，HOMA-IR低于对照组[（1.92±0.43）比（2.37±0.84）]，差异均有统计学意义（t=3.210、2.150、3.694，均P<0.05）。治疗后，观察组FPG、2 h PBG、HbA1c水平均低于对照组[（6.47±1.12）mmol/L比（7.35±0.94）mmol/L、（10.52±1.17）mmol/L比（11.83±1.59）mmol/L、（6.12±1.09）%比（6.79±1.35）%]，差异均有统计学意义（t=4.662、5.140、2.991，均P<0.05）。观察组不良反应发生率为15.00%（9/60），与对照组[18.33%（11/60）]比较，差异无统计学意义（χ²=0.240，P=0.624）。结论　与血糖谱相比，经胰岛素分泌曲线选择胰岛素促泌剂具有较好的促胰岛素分泌效果和降糖效果，有利于缩短血糖控制达标时间和住院时间，提高血糖达标率。

关键词:

2型糖尿病, 胰岛素分泌曲线, 血糖谱, 疗效