目的 探讨甘精胰岛素联合阿卡波糖对2型糖尿病患者胰岛功能的影响及可能的机制。方法 82例2型糖尿病患者随机分为治疗组和对照组,每组41例。对照组口服阿卡波糖片,起始剂量50 mg/次,3次/d,并于每日3餐主食前sc普通胰岛素,起始剂量1次0.1~0.15 U/kg;治疗组在对照组基础上将普通胰岛素改为甘精胰岛素,睡前sc甘精胰岛素1次/d,起始剂量为0.2 U/kg,均连续用药12周。比较两组治疗前后胰岛素抵抗指数(Homa-IR)、胰岛素分泌指数(Homa-β)、超氧化物歧化酶(SOD)、丙二醛(MDA)、白介素-6(IL-6),以及血糖控制情况。结果 治疗前两组Homa-IR、Homa-β、SOD、MDA和IL-6无显著性差异;治疗后两组Homa-β和SOD均显著升高,而Homa-IR、MDA和IL-6显著减低(P < 0.05,0.01),治疗组的Homa-β和SOD显著高于对照组,Homa-IR、MDA和IL-6显著低于对照组(P < 0.05)。治疗组血糖达标时间平均为(6.91±1.26)d,低血糖次数平均为(0.42±0.09)次,均显著低于对照组的(9.76±1.84)d、(1.16±0.32)次(P < 0.05,0.01)。结论 甘精胰岛素联合阿卡波糖可显著改善2型糖尿病患者氧化应激状态,提高对胰岛素的敏感性,改善胰岛功能,低血糖不良反应发生低,能快速、安全、有效地控制血糖。

Objective To detect the effect of glargine insulin combined with acarbose on islet function in patients with type 2 diabetes mellitus (T2DM) and explore its mechanisms and clinical safety. Methods A total of 82 T2DM patients were enrolled in this study. Patients were randomly divided into control group (n=41) and treatment group (n=41). Acarbose (50 mg/time, 3 times/d) and insulin (0.1-0.15 U/kg) was given in control group for 12 weeks. Acarbose (50 mg/time, 3 times/d) and glargine insulin (0.2 U/kg) were given in observation group for 12 weeks. The Homa-IR, Homa-β, SOD, MDA, IL-6, and blood glucose control were compared. Results Before treatment, There was no significant difference of Homa-IR, Homa-β, SOD, MDA, and IL-6 between the two groups. After treatment, the Homa-β and SOD in observation group were higher than those in control group (P < 0.05), and the Homa-IR, MDA, and IL-6 in observation group were lower than those in control group (P < 0.05). The blood glucose standard time, hypoglycemia number, and insulin dosage were (6.91±1.26) d, (0.42±0.09) times in observation group, which were significantly lower than that of (9.76±1.84) d, (1.16±0.32) times in control group (P < 0.05,0.01). Conclusion Glargine insulin combined with acarbose can significantly improve the oxidative stress, sensitivity of patients to insulin, and islet function in T2DM patients, with low incidence of hypoglycemia, which can fast, safely and effectively control blood glucose in T2DM patients.