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JAMA:1型糖尿病患者使用胰岛素联合二甲双胍并不能有效控制血糖

2015-12-02 Mechront 译 MedSci原创

研究者进行了一项研究,探究对于1型糖尿病超重青少年,在胰岛素的基础上添加二甲双胍对其血糖控制的有效性和安全性。该多中心、双盲、安慰剂对照的随机临床试验纳入了12.1-19.6岁 (mean [SD] 15.3 [1.7]岁) 的140名1型糖尿病(患病时长 7.0 (3.3))青少年,平均BMI位于94百分位,平均每日胰岛素使用为 1.1 (0.2) U/kg,平均HbA1c为8.8% (0.7%

研究者进行了一项研究,探究对于1型糖尿病超重青少年,在胰岛素的基础上添加二甲双胍对其血糖控制的有效性和安全性。

该多中心、双盲、安慰剂对照的随机临床试验纳入了12.1-19.6岁 (平均 [SD] 15.3 [1.7]岁) 的140名1型糖尿病(患病时长 7.0 (3.3))青少年,平均BMI位于94百分位,平均每日胰岛素使用为 1.1 (0.2) U/kg,平均HbA1c为8.8% (0.7%)。

研究者将参与者随机分为二甲双胍组 (n = 71) (≤2000 mg/d) 和安慰剂对照组 (n = 69)。初始结局指标为26周后HbA1c变化情况,继发指标包括连续血糖监测、每日胰岛素使用、BMI、腰围、身体组分、血压、血脂等变化情况。

研究数据显示,在随访13周的时候,二甲双胍组比安慰剂组HbA1c水平降低更多(−0.2% vs 0.1%;相差 −0.3% [95% CI, −0.6% to 0.0%]; P = .02);不过随访到26周的时候,两者间差异不再存在,变化均为 0.2%(相差  0% [95% CI, −0.3% to 0.3%]; P = .92)。

随访26周研究者发现每日胰岛素使用量减少25%的在二甲双胍组有23% (16),对照组有1% (1) (相差 21% [95% CI, 11% to 32%]; P = .003);BMI z分数降低至少10%的在二甲双胍组有24% (17),对照组有7% (5) (相差 17% [95% CI, 5% to 29%]; P = 0.01);胃肠道不良反应在二甲双胍组更多见 (相差 36% [95% CI, 19% to 51%]; P <0 .001)。

研究结果表明,对1型糖尿病超重青少年在胰岛素的基础上添加二甲双胍,并不能改善6个月后的血糖控制情况。虽然二甲双胍组在胰岛素使用和BMI控制上稍占优势,但该组胃肠道不良事件风险也更高。该研究结果并不支持对该类人群使用二甲双胍控制血糖。

原始出处:

Ingrid M. Libman,Kellee M. Miller, et al.Effect of Metformin Added to Insulin on Glycemic Control Among Overweight/Obese Adolescents With Type 1 Diabetes.JAMA. 2015;314(21):2241-2250.


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    2016-06-14 baoya
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    2015-12-27 忠诚向上

    很值得好学习

    0

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    2015-12-27 hixiaoluo

    好文章,值得收藏

    0

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    2015-12-27 hixiaoluo

    好文章,值得收藏

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