目的 探讨不同口服降糖药联合胰岛素对糖尿病患者胰岛β细胞功能、骨代谢和成本效果的影响，为临床治疗提供参考依据。方法 选取西安市第一医院2015年3月—2018年3月收治100例糖尿病患者，根据入院先后顺序随机分为观察组和对照组，每组50例，两组患者于每晚睡觉前皮下注射胰岛素，起始剂量为0.2 U/（kg·d），并停用其他降糖药物。观察组患者在此基础上，口服沙格列汀片5 mg/次，1次/d。对照组患者口服格列美脲片1 mg/次，1次/d，两组均连续治疗12周。对比两种不同口服降糖药物对糖尿病患者胰岛β细胞功能、骨代谢和成本的影响。结果 两组患者治疗前胰岛β细胞（Homaβ）、修正胰岛β细胞分泌指数（MBCI）、早期胰岛素分泌指数（EISI）、血糖曲线下面积（AUCglu）、胰岛素曲线下面积（AUCins）和C肽曲线下面积（AUCcp）对比无显著性差异；治疗后，两组的Homaβ、MBCI、EISI、AUCins和AUCcp水平在治疗后显著升高，而AUCglu水平治疗后显著降低，同组治疗前后比较差异均有统计学意义（P<0.05）；且观察组治疗后Homaβ、MBCI、EISI、AUCins和AUCcp水平显著高于对照组，而AUCglu水平显著低于对照组，组间差异均有统计学意义（P<0.05）。两组患者经不同用药方案治疗后的骨密度均明显改善，与同组治疗前相比具有统计学差异（P<0.05），而与对照组相比，观察组患者的骨密度改善程度更加明显，组间差异有统计学意义（P<0.05）。两组患者治疗后血糖的控制情况空腹血糖（FPG）、餐后2 h血糖（2h PG）和糖化血红蛋白（HbA1C）比治疗前均显著降低，同组治疗前后比较差异有统计学意义（P<0.05）；且观察组治疗后FPG、2h PG和HbA1C均显著低于对照组治疗后（P<0.05）。观察组患者降糖药物成本低于对照组，但两种治疗方案药物成本对比无统计学差异。结论 糖尿病患者采取口服沙格列汀降糖药物联合胰岛素治疗方案是可行的，可结合患者具体特点，在早期应用药物，改善患者的胰岛β细胞功能，改善骨代谢，控制血糖水平，延缓糖尿病进展，经济效果较佳，可减轻患者的经济负担。

Objective To investigate the effects of different oral hypoglycemic drugs combined with insulin on islet beta cell function, bone metabolism and cost-effectiveness in diabetic patients, and to provide reference for clinical treatment.Methods 100 patients with diabetes mellitus were randomly divided into study group and control group according to the order of admission, 50 patients in each group were treated with insulin. On this basis, the study group was treated with sagretine and the control group was treated with glimepiride. The effects of two different oral hypoglycemic drugs on islet beta cell function, bone metabolism and cost in diabetic patients were compared.Results There was no significant difference in Homa beta, MBCI, EISI, AUCglu, AUCins and AUCcp between the two groups before treatment. After treatment, the indexes of the study group were significantly better than those of the control group (P<0.05). The bone mineral density of the two groups were significantly improved after treatment with different drug regimens, compared with before treatment. The bone mineral density of the study group improved more significantly than that of the control group (P<0.05). The control of blood glucose after treatment in both groups was significantly lower than that of FPG, 2h PG and HbA1C after treatment (P<0.05). FPG, 2h PG and HbA1C were significantly lower in the study group than in the control group (P<0.05). The cost of hypoglycemic drugs in the study group was lower than that of the control group, but there was no statistical difference in the cost of the two treatment regimens. Conclusion It is feasible for diabetic patients to take oral saglitine hypoglycemic drugs combined with insulin therapy, which can improve the function of islet beta cells, improve bone metabolism, Control blood sugar levels, delay the progress of diabetes mellitus. The economic effect is better and can be reduced. The economic burden of patients.