Koprivica Branka, Beljić-Zivković Teodora, Ille Tatjana
Srp Arh Celok Lek. 2009 Sep-Oct;137(9-10):490-6. doi: 10.2298/sarh0910490k.
Secondary monotherapy failure in diabetes mellitus type 2 occurs early in the course of disease. Choosing the optimal combination therapy depends on the primary pathogenic mechanism. Evaluation of the residual beta cell function is of primary importance in deciding whether insulin should be included in the combination therapy.
To investigate the influence of standard meal test and homeostasis model assessment (HOMA-B) index, as markers of residual insulin secretion, on the efficacy of two different therapeutic strategies in secondary sulphonylurea (SU) failure.
In the group of thirty subjects with diabetes type 2, metabolic syndrome and secondary SU failure, metformin (MET) was added for the following six months. In the group of 30 subjects with diabetes type 2, secondary SU failure, with no metabolic syndrome, insulin (INS) was added for the same period. During the six-month follow-up period, fasting, postprandial, mean daily blood glucose and glycosylated haemoglobin (HbA1C) were evaluated. Fasting and meal stimulated C-peptide (CP) and insulin levels were measured at the beginning; absolute and relative increase of CP (delta CP, delta CP%), and HOMA-B were calculated. Correlation between CP secretion and HOMA-B at the beginning and glycaemic control after six months of therapy were evaluated by using Pearson correlation coefficient.
Glycaemic control after six months was significantly improved in both therapeutic combinations (p < 0.01). However, target values were not met in either group. Stimulated CP levels correlated best with all the parameters of glycaemic control in the group SU+MET (r -0.479 to -0.791; p < 0.01), and in the group SU+INS (r 0.382 to 0.635; p < 0.01). HOMA-B correlated only with HbA1C in the SU+MET group (r = -0.382; p < 0.05).
Clinical diagnosis of metabolic syndrome and evaluation of residual insulin secretion are necessary in choosing the best combination therapy in secondary SU failure in subjects with type 2 diabetes. Stimulated standard meal CP level is a clinically useful marker of residual insulin secretion.
2型糖尿病继发性单药治疗失败在疾病进程早期就会出现。选择最佳联合治疗方案取决于主要致病机制。评估残余β细胞功能对于决定联合治疗中是否应包含胰岛素至关重要。
研究作为残余胰岛素分泌标志物的标准餐试验和稳态模型评估（HOMA-B）指数对继发性磺脲类药物（SU）治疗失败的两种不同治疗策略疗效的影响。
在30例患有2型糖尿病、代谢综合征且继发性SU治疗失败的受试者组中，加用二甲双胍（MET）治疗六个月。在30例患有2型糖尿病、继发性SU治疗失败且无代谢综合征的受试者组中，同期加用胰岛素（INS）。在六个月的随访期内，评估空腹、餐后、每日平均血糖和糖化血红蛋白（HbA1C）。在开始时测量空腹和餐后刺激后的C肽（CP）和胰岛素水平；计算CP的绝对和相对增加量（δCP，δCP%）以及HOMA-B。使用Pearson相关系数评估开始时CP分泌与HOMA-B之间以及治疗六个月后血糖控制之间的相关性。
两种治疗组合在六个月后的血糖控制均有显著改善（p < 0.01）。然而，两组均未达到目标值。在SU + MET组中，刺激后的CP水平与所有血糖控制参数的相关性最佳（r -0.479至-0.791；p < 0.01），在SU + INS组中（r 0.382至0.635；p < 0.01）也是如此。HOMA-B仅在SU + MET组中与HbA1C相关（r = -0.382；p < 0.05）。
在为2型糖尿病患者继发性SU治疗失败选择最佳联合治疗方案时，代谢综合征的临床诊断和残余胰岛素分泌的评估是必要的。刺激后的标准餐CP水平是残余胰岛素分泌的一个临床有用标志物。
