Clinical Observation On The Combined Effect Of Vildagliptin And Metformin In Patients With Type2Diabetes Melitus

Type2diabetes is a chronic, progressive metabolic disease, its main features isinsulin resistance, the relative lack of insulin and the blood glucose. Currently clinicaladmiral metformin as the preferred hypoglycemic drugs.Metformin, mainly byreducing the output of glycogen, reduce the intestinal absorption of glucose, increaseperipheral blood glucose intake and use, to improve the effect of insulin sensitivity.Vildagliptin is a new kind of oral hypoglycemic drugs in the treatment of type2diabetes, it mainly based on glucagon-like peptide1(glp-1) treatment, can restrainhigh selective and reversible dipeptidyl peptidase IV(DPP-4), and improve theendogenous glucagon like peptide1(glp-1), glucose romote insulin dependentpolypeptide (GIP) level, thus improve the alpha and beta cells to the glucosesensitivity, reduce the beta cell apoptosis, increase the replication, inhibits betweenmeals and glycogen output at night, and by improving insulin resistance so as tofurther reduce blood sugar.Objective: This study selected patients with type2diabetes in shenyang aftertreatment with metformin poor glycemic control as experimental objects. For thetreatment of metformin combined Vildagliptin comparing with high doses ofmetformin treatment, to compare the difference of treatment, efficacy, and safety.ofblood glucose and glycated hemoglobin (HbA1c)Methods: According to inclusion and exclusion standards, a total of80casescollected qualified research object. First of all give each the twice a day, around theobject of study for each500mg metformin, then with the method of randomlyassigned into two groups: Vildagliptin in combination with metformin as a total of42cases of treatment group, the use of high doses of metformin alone as control group atotal of38patients. Teatment duration of24weeks. Observe patients before and aftermedication glycosylated hemoglobin, fasting blood glucose, blood routine, hepaticfunction, renal function, blood lipids, blood amylase, urine routine andelectrocardiogram, at the same time record in the study of adverse events.Results:(1) In the experimental group， the difference of the HbA1c levelbetween observation period4、5and observation period2is outstanding(F=119.086， P<0.05); The difference of the FPG level between observation period3、4、5andobservation period2is outstanding (F=59.225, P<0.05); Multiple comparisonresults show that different observation during the observation period4, and5ofHbA1c level compared with observation period2is significantly difference (P<0.05);Observation sampling period3,4,5FPG levels compared with observation period2issignificant difference (P<0.05).(2) In the experimental group, the difference of thelevel of ALT, AST and TB, ALP, Cr, TG, AMS between the before and after treatmenthas no significant difference (P>0.05); DB, BUN and TC after experimentalcombination treatment compared with the before is significantly differente (P <0.05),and after the treatment of DB, BUN and TC significantly lower than before treatment.Combination therapy of the experimental group before and after treatment, only TCand TG appear outside the normal reference range of outliers, TC and TG before andafter treatment of abnormal value comparison have significant difference (P <0.05).(3) The control group, f the difference of the HbA1c level between observation period4、5and observation period2is outstanding (F=122.501, P <0.05); The differenceof the FPG level between observation period3、4、5and observation period2isoutstanding(F=62.783, P <0.05). Multiple comparison results show that differentobservation during the observation period4, and5of HbA1c level compared withobservation period2is significantly difference (P<0.05); Observation period3,4,5of the results of FPG level compared with observation period2had significantdifference (P <0.05).(4) In the control group， the difference of the level of ALT,AST and TB, ALP, Cr, TG, AMS between the before and after treatment has nosignificant difference (P>0.05) respectively. The difference of the level of TB, DBbetween before and after treatment is outstanding (P <0.05), and after the treatmentof TB, DB, significantly lower than before treatment. The control group before andafter treatment, only the TC and TG appears outside the normal reference range ofoutliers, other biochemical indexes before and after treatment were changing constant.TC and TG before and after treatment of abnormal value comparison have nosignificant differences (P>0.05).(5) The FPG levels in experimental group comparedwith control group has significant difference (t=5.660, P<0.05); The experimentalHbA1c level compared with the control group has significant difference (t=5.660, P<0.05); the population in the experimental group which is controlled level of FPG is21, which success rate is53.8%; the population in the control group which iscontrolled level of FPG is2, which success rate is5.9%, two groups of FPG controlsuccess rate have significant difference (χ2=19.364, P <0.05); the population in theexperimental group which is controlled level of HbA1c is30, which success rate is76.9%, the FPG achieve control of the target in treatment group have6cases,success rate17.6%, two groups of FPG control success rate have significantdifference (χ2=25.534, P <0.05).(6) In this study, the experimental group in thegastrointestinal tract reaction is2cases,5.1%of the total, the control group in thegastrointestinal tract reaction is7cases,14.7%of the total, there are no significantdifference compared to the (χ2=2.714, P>0.05).Conclusion:(1)In the group which Low Dose Metformin had no effect,defference of level of FPG、HbA1c between the group which used the combined effectof Vildagliptin and metformin and the group which used high dosd Metfomin wasoutstanding.But the combined effect of Vildagliptin and metformin is better than theeffect of high dosd Metfomin.(2) Adverse Drug Reaction in the group which used thecombined effect of Vildagliptin and metformin was less than the group which usedhigh dosd Metfomin；Two treatments had no significant effect on liver function, renalfunction, blood lipids, amylase index; two group didn’t have hypoglycemia, twotreatment have good security.