The Follow-up Study Of Metformin And Insulin Combined With Sitagliptin And Voglibose Respectively To Apply To Newly Diagnosed Type 2 Diabetes Mellitus

Objective: The patients with newly diagnosed type 2 diabetes mellitus(type 2 Diabetes mellitus,T2DM)whose recent blood glucose was significantly increased were treated with Metformin and insulin combined with sitagliptin or voglibose respectively,the auther intends to compare the therapeutic effects after 3 months and to explore the optimal therapeutic method for the newly diagnosed T2 DM.Methods: 32 newly diagnosed T2 DM subjects were enrolled which hospitalized in XX from March 2015 to February 2016.The patients were eligible if the fasting plasma glucose(FPG)> 11.1mmol/L and /or glycosylated hemoglobin ?9% as well as the histroy of T2 DM less than one year and had not been treated with any antidiabetic therapy.They were randomly divided into the sitagliptin group(S group,n=16cases)and the voglibose group(V group,n=16cases).Then treat with CSII immediately and metformint to eliminate the toxicity of hyperglycemia.Stoped the CSII when the FPG<10.0mmol/L for two days,then texted the function of islet,at the same time exchang insulin glargine(Lantus,Sanofi production)subcutaneous injection at 21:00 in the evening and metformin0.5g,three times a day orally controlled glucose.Based on that S group take sitagliptin 100 mg 15 minutes before breakfast and V group take sitagliptin0.2mgduring the meal orally,3 times a day.According to the glucose adjust the dose of insulinand,control FBG <7.0mmol/L and 2h PBG <10.0mmol/L,the patients can dischage when glucose were satisfied.After dischage,continue the treatment therapy for3 months,follow-up the patients every half month to adjust the appropriate dosage.After 3 months,follow-up the patient's blood biochemical markers and fill in the blank.Compared the two groups before and after treatment the difference of the weight,FPG,Hb A1 c,0h,2h C peptide,time to stop using insulin.Meanwhile,compare the rate of hypoglycemia in two groups.resistance index(HOMA-IR).Apply steady-state model to calculate the ?-cell function(HOMA-?)and insulin resistance index(HOMA-IR)to kown about the two groups and between the groups the situation of improvement.Results:1.Before and after therapy FPG(S Group:14.99±2.73mmol/L to 6.28±0.77mmol/L,V Group: 14.50±3.11mmol/L to 8.78±1.86mmol/L)and Hb A1c(S Group:11.90±1.54% to5.90±0.31%,V Group:10.63±1.18% to 6.92±1.30%)?2h PPG(S Group:20.45±2.59mmol/L to 12.41±2.48mmol/L,V Group:20.02±2.80mmol/L to 13.96±1.61Lmmol/L)in the two groups were decreased significantly(P<0.001),and the FPG?Hb A1 c of S Group were decreased significantly than V group(P=0.002?0.04),but there was no significant difference between the two groups in terms of 2h PPG(P=0.16).2.Extra-benefit: Before and after therapy weight(S Group : 76.08±13.64kgto71.31±10.16 kg,V Group:76.85±9.26 kg to 75.31±9.38kg)in the two groups were decreased significantly(P<0.05),and there was significant difference between the two groups in terms of weight(P<0.05),after therapy,the weight of S Group were decreased significantly(P<0.05)than V group.During in hospitalization and 3 months after leaving hospital,only 1 patients(7.7%)have hypoglycemia in S group,3patients(23.08%)in the Vgroup,all patients can tolerate.According to insulin adjustment scheme,the time of sitagliptin(32.92±15.12)was significant difference(P<0.05)with voglibose(50.92±2.72),the group of sitagliptin's time was significantly less than the group of voglibose.3.Before and after therapy HOMA-?(S Group:18.70±6.38 to 90.09±54.27,V Group:18.70±8.89 to 45.79±20.54)were increased(P<0.001)in the two groups,and the HOMA-? of S Group were increased significantly(P=0.01)than V group.After treatment,the S group of HOMA-IR after treatment(3.95±0.50)compared the before(5.61±1.51)were decreased significantly(P<0.001).the V group after treatment(3.65±0.79)compared before(4.91±1.08)were decreased significantly(P=0.007).Compared two group's,HOMA-IR After treatment,there was no significant difference(P =0.06).Conclusion:1.In newly diagnosed T2 DM patients,Insulin and metformin combined with sitagliptin or voglibose can significantly improve glycemic control,and the FPG ?Hb A1 c of S Group were decreased significantly than V group.2.Compared with voglibose,Sitagliptin have more advantage in weight and the insulin take off time,?-cell function.But there was no significant difference in insulin resistance.3.Sitagliptin and voglivose were well tolerated in hypoglycaemia,they all safe.