Diabetes Res Clin Pr：米格列醇/米格列奈联合比单药治疗更有效

在日本2型糖尿病患者，为了评估米格列醇与米格列奈单独或联合使用对代谢谱和肠促胰岛素分泌的功效。来自日本川崎医科大学的Mitsuru Hashiramoto教授及其团队进行了一项研究，该研究发现米格列醇/米格列奈联合使用比单药治疗在减少餐后血糖波动和同时减少额外胰岛素分泌，改善血糖控制方面更有效。该研究同时证明米格列醇和米格列奈对肠促胰岛素分泌的影响有显著差异。该研究结果在线发表在5月24日的《糖尿病研究与临床实践》（Diabetes research and clinical practice）杂志上。

该研究中，饮食和运动基础上加用或不加用二甲双胍的患者被随机分配接受米格列醇、米格列奈、或联用米格列醇与米格列奈，每日三次，治疗12周。

该研究结果表明，第12周，所有三组HbA1c显著下降（p＜0.001），1、5–AG显著增加（p＜0.001），在联合治疗组观察到最显著地变化。通过进餐负荷试验证明所有三种干预有效改善餐后高血糖，但米格列醇组血清胰岛素浓度没有增加。在之前没有使用二甲双胍治疗的患者亚组中，在最初联合治疗的患者达到更快和更好的血糖控制。在进餐负荷后，仅在米格列醇单药治疗的患者血清总GLP–1显著增加（p＜0.05），并且12周后，使用米格列醇的患者血清总GIP显著下降（p＜0.01）。

该研究发现，米格列醇/米格列奈联合使用比单药治疗在减少餐后血糖波动和同时减少额外胰岛素分泌，改善血糖控制方面更有效。该研究同时证明米格列醇和米格列奈对肠促胰岛素分泌的影响有显著差异。

Concomitant use of miglitol and mitiglinide as initial combination therapy in type 2 diabetes mellitus.
AIM
To evaluate the efficacy of miglitol and mitiglinide alone or in combination on the metabolic profile and incretin secretion in Japanese type 2 diabetes patients.
METHODS
Patients on diet and exercise with or without metformin, were randomized to receive either miglitol, mitiglinide, or a combination, three times daily for 12 weeks.
RESULTS
At 12 weeks, HbA1c decreased significantly (p<0.001) and 1,5-AG increased significantly (p<0.001) in all three groups, with the greatest change seen with combination therapy. Effective improvement of postprandial hyperglycemia was demonstrated by a meal-loading test in all three interventions but serum insulin concentration was not increased by miglitol. In a subset of patients without prior metformin administration, faster and better glycemic control was achieved with the initial combination. After meal loading, serum total GLP-1 significantly increased only with miglitol monotherapy (p<0.05) and serum total GIP significantly decreased (p<0.01) in the arms employing miglitol after 12 weeks.
CONCLUSION
Miglitol/mitiglinide combination is more potent than monotherapy in improving glycemic control through the reduction of postprandial glucose excursion and the simultaneous sparing of additional insulin secretion. A marked difference in the effects of miglitol and mitiglinide on incretin secretion was also demonstrated.