二甲双胍联合利拉鲁肽干预糖尿病前期的中期效果观察.

OBJECTIVE: To probe into the effects of metformin combined with liraglutide on the prognosis of prediabetes. METHODS: Totally 180 patients with prediabetes of impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) admitted into Kailuan General Hospital in 2018 were selected to be randomly divided into group A (lifestyle intervention ), group B ( lifestyle intervention and metformin ) and group C ( lifestyle and metformin combined with liraglutide), with 60 cases in each group, and 20 cases in each subgroup of IFG, IGT and IFG+IGT. Follow-up was conducted every 6 months after intervention, fasting blood glucose (FBG), 2-hour postprandial blood glucose ( 2 hBG), glycosylated hemoglobin ( HbA1 c), serum total cholesterol ( TC) levels and body mass index (BMI) were measured. Diagnosis of diabetes was the observation endpoint. And the incidences of adverse drug reactions were recorded. RESULTS: Totally 175 cases were followed up for an average of (28. 56±4. 03) months. At the last follow-up, the 2 hBG level of IGT subgroup in group A was lower than that before the intervention, with statistically significant difference (P<0. 05). The FBG levels of IFG and IFG + IGT subgroups in group B and group C were lower than those before the intervention, and the 2 hBG levels of IGT and IFG + IGT subgroups were lower than those before the intervention, which were all lower than the same subgroups in group A, with statistically significant differences (P<0. 05). The FBG level of IFG subgroup and 2 hBG level of IFG + IGT subgroup in group C were lower than those of the corresponding subgroup in group B, with statistically significant differences (P<0. 05). The HbA1 c levels of IFG subgroup in group A were higher than those before the intervention, and the HbA1 c levels of the remaining groups were lower than those before the intervention, but there were no statistically significant differences before and after intervention and between groups(P>0. 05). the TC levels of each subgroup in group B and group C were lower than those in group A, the BMI of each subgroup in group C was lower than that in group A, the BMI of IGT and IFG+IGT subgroups in group C were lower than those in group B, with statistically significant differences (P<0. 05). The progression rate of type 2 diabetes was 18. 97% (11 / 58) in group A, 6. 78% (4 / 59) in group B and 0% ( 0 / 58) in group C, group B was lower than group A, group C was lower than groups A and B, with statistically significant differences (P<0. 05). The incidences of adverse drug reactions in groups B and group C was 10. 17% (6 / 59) and 17. 24% ( 10 / 58), respectively, with no statistically significant differences between groups (P>0. 05 ). CONCLUSIONS: Compared with lifestyle intervention alone, both metformin alone and metformin combined with liraglutide can improve impaired fasting glucose and impaired glucose tolerance, and reduce the risk of progression to diabetes in prediabetic populations. The application of metformin combined with liraglutide is better. [ABSTRACT FROM AUTHOR]

目的:探讨二甲双胍联合利拉鲁肽对糖尿病前期患者疾病转归的影响。 方法:抽取 2018 年开滦总医院收治的空腹血糖 受损(IFG)或糖耐量减低(IGT)的糖尿病前期患者 180 例,随机分为 A 组(生活方式干预)、B 组(生活方式干预+二甲双胍)、C 组 (生活方式干预+二甲双胍+利拉鲁肽),每组 60 例,IFG、IGT 和 IFG+IGT 每个亚组各 20 例。 三组患者干预后每 6 个月进行 1 次随 访,检测空腹血糖(FBG)、餐后 2 h 血糖(2 hBG)、糖化血红蛋白(HbA1 c)和血清总胆固醇(TC)水平,计算体重指数(BMI)。 确诊 糖尿病为观察终点。 记录不良反应发生情况。 结果:共 175 例患者完成随访,平均随访(28. 56±4. 03)个月。 末次随访时,A 组 IGT 亚组患者的 2 hBG 水平低于干预前,差异有统计学意义(P<0. 05)。 B 组和 C 组中 IFG、IFG+IGT 亚组患者的 FBG 水平低于干 预前,IGT、IFG+IGT 亚组患者的 2 hBG 水平低于干预前,且均低于 A 组对应亚组,差异均有统计学意义(P<0. 05)。 C 组中 IFG 亚 组患者的 FBG 水平和 IFG+IGT 亚组患者的 2 hBG 水平低于 B 组对应亚组,差异均有统计学意义(P<0. 05)。 A 组中 IFG 亚组患 者的 HbA1 c 水平高于干预前,其余组的 HbA1 c 水平均低于干预前,但干预前后和组间的差异无统计学意义(P>0. 05)。 B 组和 C 组各亚组患者的 TC 水平低于 A 组,C 组各亚组患者的 BMI 低于 A 组,C 组 IGT 和 IFG+IGT 亚组患者的 BMI 低于 B 组,差异均 有统计学意义(P<0. 05)。 A 组患者的 2 型糖尿病进展率为 18. 97%(11 / 58),B 组为 6. 78%(4 / 59),C 组为 0%(0 / 58),B 组低于 A 组,C 组低于 A 组、B 组,差异均有统计学意义(P<0. 05)。 B 组、C 组患者的不良反应发生率分别为 10. 17%(6 / 59)、17. 24% (10 / 58),组间差异无统计学意义(P>0. 05)。 结论:与单纯生活方式干预比较,二甲双胍和二甲双胍联合利拉鲁肽治疗均能改善 患者的 IFG 和 IGT 情况,降低糖尿病前期人群进展为糖尿病的风险。 二甲双胍联合利拉鲁肽的应用效果更佳。 [ABSTRACT FROM AUTHOR]