The Influence Of Sitagliptin On Each Index Of Type2Diabetic Patients With Large-dose Insulin Therapy

With living standard improvement and aging process, the morbidity ofdiabetes mainly type2diabetes is increasing gradually. Insulin therapy isimportant for type2diabetes. Some diabetic patients with large doses of insulinhave the ideal blood glucose in short time. However, the literatures about thecontrol of each index of diabetic patients with large doses of insulin for longtime is limited. Therefore, we will explore this section as reference for clinicaltreatment. In recent years, the drugs based on the research and development ofincretin is becoming a hot spot of treatment for type2diabetes, sitagliptin caninhibit the DPP-4hydrolysis to incretin so that GLP-1concentration increases, itachieves hypoglycemic effect through various mechanisms.Objective:The aim of this research is to explore:(1)The control of each index of type2diabetic patients with large-dose insulin therapy for long time, including bloodglucose, blood lipid, blood pressure and body mass index.(2)The influence ofsitagliptin on each index of type2diabetic patients with large-dose insulintherapy.Methods:Type2diabetic patients were enrolled (n=125) from May,2012to May,2013. The ages of patients were30-60years and those with diabetes for5-10years, there was no limit in sex. The time for patients with simple insulintherapy at a stable dose was at least6months. The patients were divided intotwo groups according to daily insulin dosage: the daily insulin dosage in Agroup (n=60) was50-78U and the average of it was60.24±6.74U; the dailyinsulin dosage in B group (n=65) was12-48U and the average of it was 37.94±6.62U. There were no significant differences between two groups ingeneral information. At the same time, we recorded the blood pressure, heightand weight of patients, calculated body mass index. Tested fasting blood glucose,2hours postprandial blood glucose, HbA1c, triglyceride, total cholesterol, lowdensity lipoprotein-cholesterol, high density lipoprotein-cholesterol, fastingserum insulin and C peptide, recorded the frequency of hypoglycaemia andweight changes in6months.Type2diabetic patients with HbA1C>7.0%were enrolled (n=40) from Agroup. All the patients on the basis of insulin treatment combined withsitagliptin100mg/d oral before breakfast for12weeks. Tested fasting bloodglucose,2h postprandial blood glucose, HbA1C, triglyceride, total cholesterol,low density lipoprotein-cholesterol, high density lipoprotein-cholesterol after12weeks, measured blood pressure and weight, calculated body mass index anddaily insulin dosage after treatment, recorded the occurrence of adversereactions.Results:1. A group patients had higher levels of fasting blood glucose,2hourspostprandial blood glucose, HbA1c, triglyceride, low density lipoprotein-cholesterol and body mass index compared with B group patients (p<0.05).There were no significant differences in total cholesterol, high densitylipoprotein-cholesterol, blood pressure and fasting serum C peptide between twogroups (p>0.05). A group patients had a higher level of fasting serum insulincompared with B group patients (p<0.05). The average of weight changes andthe incidence of hypoglycaemia in A group were higher than B group (p<0.05).2. After12weeks treatment added with sitagliptin, the levels of fastingblood glucose,2h postprandial blood glucose, HbA1C, triglyceride, low densitylipoprotein-cholesterol, systolic blood pressure and diastolic blood pressurewere decreased significantly (P<0.05). Body mass index and daily insulin dosage were decreased significantly (P<0.05). There were no significantdifferences in total cholesterol, high density lipoprotein-cholesterol before andafter the treatment (P>0.05). The incidence of hypoglycemia is2.5%.Conclusion:1. Large-dose insulin therapy will increase type2diabetic patients’hypoglycaemia incidience and is not conducive to weight control.2. Large-dose insulin therapy maybe not conducive to blood glucose andblood lipid control.3. The therapy of sitagliptin combined with large doses of insulin isconducive to blood glucose control and glycated hemoglobin control.4. The therapy of sitagliptin combined with large doses of insulin isconducive to blood lipid and blood pressure control.5. The therapy of sitagliptin combined with large doses of insulin canreduce the daily insulin dosage and weight, the risk of hypoglycemia is low.