目的 探讨二甲双胍联合优泌林治疗初发糖尿病病足的肥胖2型糖尿病的疗效。方法 选取2010年1月-2013年1月上海市嘉定区安亭医院就诊的初发糖尿病足的肥胖2型糖尿患者80例，随机分为治疗组与对照组，每组40例。两组患者均口服二甲双胍1.5 g/d。治疗组在口服二甲双胍的同时，注射优泌林，起始剂量早15 U/d、晚10 U/d，严密监测血糖，如没有出现低血糖的症状，逐渐加量至早40 U/d、晚30 U/d。观察比较两组患者治疗前及治疗12周后的糖化血红蛋白（HbAlC）、空腹血糖（FBG），并测量计算治疗前后患者的踝肱指数（ABI）、餐后2 h血糖（2hPBG）、体质量指数（BMI）。同时于治疗12周后观察询问患者足部病变如干燥、皲裂、足癣以及胼胝的改善情况。结果 治疗12周后，两组患者的ABI均高于治疗前，并且治疗组高于对照组，差异具有统计学意义（P<0.05）。而两组患者的HbAlC、FBG、2hPBG和BMI均低于治疗前，并且治疗组低于对照组，差异具有统计学意义（P<0.05）。同时两组患者的足部病变改善情况均优于治疗前，并且治疗组患者的足部病变改善情况明显优于对照组（P<0.05）。结论 二甲双胍联合优泌林的治疗对于初发糖尿病足的肥胖2型糖尿病患者的足部血管改善、足部病变恢复及血糖控制具有更好的效果，推荐临床使用。

Objective To explore the efficacy of metformin combined with Humulin in the treatment of obese type 2 diabetes with onset diabetic foot. Methods Obese type 2 diabetic patients (80 cases) with onset diabetic foot, who came to Anting Hospital of Shanghai Jiading District from January 2010 to January 2013 for the treatment, were randomly divided into treatment and control groups (40 cases in each group). The patients in the both groups were given metformin 1.5 g/d. The patients in the treatment group were given metformin combined with Humulin, the starting dose was 15 U/d in the morning, and 10 U/d in the evening. The blood sugar was closely monitored, if there was not the symptom of hypoglycemia, the amount to 40 U/d was gradually added in the morning, and 30 U/d in the evening. The hemoglobin (HbAlC), fasting blood glucose (FBG), 2 h postprandial blood glucose (2hPBG), body mass index (BMI), ankle-brachial index (ABI), and the improvement of foot lesions between the two groups were compared before and 12 weeks after the therapy. Results After 12 weeks of the treatment, ABI was significantly higher than that in the same group before the treatment, and the differences between the two groups was statistically significant (P< 0.05). HbAlC, FBG, 2hPBG, and BMI were lower than those in the same group before the treatment. And there were the significant differences between the two groups (P< 0.05). The improvement of foot lesions was better than that in the same group before the treatment, and the differences between the two groups were statistically significant (P< 0.05). Conclusion Metformin combined with Humulin could be better in the control of blood glucose and the improvement of blood supply and foot lesions of obese type 2 diabetic patients with onset diabetic foot. It is worth of clinic application.

上海市嘉定区科学技术发展资助项目（2012-18）