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JAMA Intern Med:使用大剂量胰岛素的2型糖尿病患者可以尝试加入GLP1受体激动剂

2016-06-07 MedSci MedSci原创

背景越来越多的2型糖尿病患者接受高剂量的胰岛素。如此便会导致患者出现体重增加、低血糖,治疗费用高昂。目的 该研究的目的在于评估对注射大剂量胰岛素的2型糖尿病患者添加GLP1受体激动剂的有效性和安全性。 方法该研究采取双盲、安慰剂对照、随机(1:1)实验,研究人员还对参与者进行了6个月的随访研究,研究地点位于德克萨斯大学西南医学中心和柏龄纪念医院。研究时间为2012年8月13日-2015年2月9日。

背景

越来越多的2型糖尿病患者接受高剂量的胰岛素。如此便会导致患者出现体重增加、低血糖,治疗费用高昂。

目的

该研究的目的在于评估对注射大剂量胰岛素的2型糖尿病患者添加GLP1受体激动剂的有效性和安全性。

方法

该研究采取双盲、安慰剂对照、随机(1:1)实验,研究人员还对参与者进行了6个月的随访研究,研究地点位于德克萨斯大学西南医学中心和柏龄纪念医院。研究时间为2012年8月13日-2015年2月9日。参与者为71名血糖控制不佳的2型糖尿病患者(糖化血红蛋白水平:7.5%——11.0%)胰岛素使用剂量超过1.5 U/kg/d。实验组患者注射 利拉鲁肽(1.8 mg/d),对照组采用安慰剂,时长为6个月。研究人员关注的主要结果是患者糖化血红蛋白水平的变化。次要结果是患者体重的变化、发生低血糖的次数、胰岛素用量和生活质量。

结果

71名患者中,45人(63%)为女性,平均年龄为54.2(7.4)岁,平均2型糖尿病患病时间为17.9(8.4)年,平均每日注射的胰岛素总剂量(SD)为247.0(95.1)U。93%(66/71)的参与者完成了所有随访调查。实验组患者糖化血红蛋白水平提高9.0%(1.2%)-7.9%(1.1%)(P <0.001),对照组不变(8.9%),治疗差异为0.9%(95%:CI:−1.5-−0.4)(P =0.002)。 实验组患者体重由平均114.6kg(21.4)下降至113.6kg(20.8),对照组患者体重由平均116.1kg(26.6)升至117.2kg(27.2),治疗差异为−2.3 kg (95% CI:−4.3-−0.4kg)(P =0.02)。实验组患者每日注射胰岛素总量减少11.5%(95% CI:−21.8%-−1.1%)(P=0.20)。第一个月内,实验组患者低血糖发生率较对照组高(2.30:0.91,P =0.01),但总体而言两组患者低血糖发生率相似(P =0.11)。实验组患者对治疗的满意度高于对照组。

结论

研究人员指出,在大剂量胰岛素中加入GLP1受体激动剂可改善2型糖尿病患者血糖控制情况,降低体重,并提高患者的治疗满意度。但研究人员表示仍需进行更进一步的探究以评估这种治疗方案的长期风险和安全性。

原始出处:
Effect of Adding Liraglutide vs Placebo to a High-Dose lnsulin Regimen in Patients With Type 2 Diabetes,A Randomized Clinical Trial,Anna Vanderheiden,JAMA Intern Med,6,June,2016

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  1. 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encodeId=7625160694231, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Thu Jun 09 01:24:00 CST 2016, time=2016-06-09, status=1, ipAttribution=)]
    2016-09-21 1e10c84am36(暂无匿称)

    文章很好,非常有益

    0

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    2016-09-15 舒心和人

    这是个好方法,感谢分享

    0

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encodeId=7625160694231, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Thu Jun 09 01:24:00 CST 2016, time=2016-06-09, status=1, ipAttribution=)]
    2016-12-17 baoya
  4. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Mon Aug 01 19:49:00 CST 2016, time=2016-08-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1383220, encodeId=2964138322035, content=<a href='/topic/show?id=196a1101f7' target=_blank style='color:#2F92EE;'>#2型糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1101, encryptionId=196a1101f7, topicName=2型糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec19483, createdName=aids213, createdTime=Thu Jun 09 01:24:00 CST 2016, time=2016-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1473991, encodeId=a0ee14e3991f3, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, 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encodeId=7625160694231, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Thu Jun 09 01:24:00 CST 2016, time=2016-06-09, status=1, ipAttribution=)]
    2016-08-20 doctorJiangchao

    继续学习

    0

  5. 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    2016-08-20 doctorJiangchao

    继续关注

    0

  6. 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encodeId=7625160694231, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Thu Jun 09 01:24:00 CST 2016, time=2016-06-09, status=1, ipAttribution=)]
    2016-08-01 忠诚向上

    值得学习

    0

  7. 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  9. 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ECE 2106:联合胃和肠道的减肥手术对糖尿病患者更有益

欧洲内分泌学大会上称,肥胖和2型糖尿病患者经历改道胃袖状切除回肠换位或迷你胃旁路手术,与袖状胃切除术患者相比,30天后的血糖控制情况更佳。伊斯坦布尔代谢外科诊所的医疗主任Alper Celik博士道,“许多肥胖的糖尿病患者仅靠药物是不能很好的控制血糖的, 我们进行了一项前瞻性队列研究,比较三种不同减肥手术方案,对患者术后30天的血糖控制的影响。”该研究纳入了251名2型糖尿病和肥胖患者(平均年龄5

ECE 2016:1型糖尿病患者好好控制血糖,有利于骨骼健康

欧洲内分泌学大会上称,改善HbA1c可能会减缓解1型糖尿病患者骨矿物质密度的损失和骨转换风险。希腊色萨利大学内分泌和代谢疾病部分的Eleftheria Barmpa和同事对107名1型糖尿病患者(平均年龄34岁,48名男性,平均糖尿病病程15年,平均BMI 23.2 kg/m²,平均 HbA1c )和95名健康对照组(年龄、性别和BMI匹配)进行了研究。使用DXA扫描监测参与者腰椎和股骨颈情况,此

ECE 2016:减肥手术可改善2型糖尿病患者的神经病变

欧洲内分泌学大会上公布结果显示,血糖控制不佳的2型糖尿病和肥胖患者在经历腹腔镜回肠转位袖状胃切除术后1个月,其糖尿病神经病变症状显著改善。“所谓的“不可逆”的糖尿病神经病变是可逆的,”伊斯坦布尔代谢外科诊所的医疗主任Alper Celik博士说,“几乎三分之二的患者在代谢手术后糖尿病神经病变得到改善,不管术后体重和血糖控制的变化。”这项横断面非盲的前瞻性研究纳入了55名血糖控制不佳的2型糖尿病和肥

SJVF2016:梅斯医学专访汤敬东教授:糖尿病足的信息化管理

第五届上海交通大学血管病论坛(SJVF2016)于2016年6月3-5日在上海隆重举行。本届SJVF由上海交通大学医学院附属第九人民医院承办。大会共同主席汤敬东教授带来了“糖尿病足信息化平台建设”经验。梅斯医学作为媒体合作单位,发来现场报告。 专家简介: 汤敬东,副教授,血管外科博士,博士后。现担任上海交通大学附属第一人民医院血管外科主任。2000年-2010年

J Immunol:糖尿病如何干扰机体免疫系统的功能?

图片来源:medicalxpress.com 近日,来自哈利珀金斯医学研究所的一组研究人员通过研究揭示了1型糖尿病如何干扰机体免疫系统的功能,同时研究者还阐明了个体患1型糖尿病的新型分子机制。相关研究刊登于国际杂志Journal of Immunology上。 研究者Grant Morahan教授表示,并不像很多其它的遗传性疾病,引发1型糖尿病的基因往往会通过调节其它基因的表达水平来促使疾

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