Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
J Diabetes Complications. 2011 Sep-Oct;25(5):332-8. doi: 10.1016/j.jdiacomp.2011.06.004. Epub 2011 Aug 2.
Although sulfonylurea added to metformin is the first oral drug combination regimen for patients with type 2 diabetes recommended by the American Diabetes Association/European Association for the Study of Diabetes consensus statement, it does not allow for individualizing and optimizing therapy with respect to sustaining glycemic control and the reduction of glucose variability. We therefore sought to investigate acarbose as an alternative to glibenclamide in combination with metformin and compare the effects on metabolic control and glucose variability.
Type 2 diabetic patients 30-70 years of age with glycosylated hemoglobin 7.0%-11.0% while treated with one or two oral antidiabetic drugs were successively enrolled. After 8 weeks of run-in with metformin 500 mg thrice daily, either acarbose 50 mg or glibenclamide 2.5 mg three times daily was randomly added on and force titrated to acarbose 100 mg or glibenclamide 5.0 mg three times daily for the subsequent 16 weeks. Demographic data, biochemical data and continuous glucose monitoring system data were recorded upon randomization and at the end of the study. Various parameters that measure glucose variability were derived from the continuous glucose monitoring system data.
Of the 51 type 2 diabetes patients enrolled, data from 40 subjects, 20 in each group, were analyzed after excluding those unqualified information. Both drug combinations improved glycemic control. Glucose variability, expressed as mean amplitude of glycemic excursion or continuous overall net glycemic action and mean of daily differences, decreased significantly (all P<.05) after the addition of acarbose but not glibenclamide. The acarbose-metformin combination has the additional benefits of weight reduction and shorter durations of hyperglycemia compared with metformin monotherapy.
This study suggests that both intraday and interday glucose variability are more effectively reduced by the acarbose-metformin combination than by the glibenclamide-metformin combination, while both combinations reduce the overall glucose level equally.
尽管美国糖尿病协会/欧洲糖尿病研究协会共识声明推荐磺酰脲类药物联合二甲双胍作为 2 型糖尿病患者的一线口服药物治疗方案，但这种方案在维持血糖控制和降低血糖波动方面无法实现个体化和优化治疗。因此，我们旨在研究阿卡波糖作为与二甲双胍联合的替代药物，并比较其对代谢控制和血糖波动的影响。
30-70 岁、糖化血红蛋白 7.0%-11.0%、正在接受一种或两种口服降糖药物治疗的 2 型糖尿病患者连续入选。在服用 500mg 二甲双胍每日三次 8 周的导入期后，随机加用阿卡波糖 50mg 或格列本脲 2.5mg 每日三次，并随后强制滴定至阿卡波糖 100mg 或格列本脲 5.0mg 每日三次，共 16 周。在随机分组时和研究结束时记录人口统计学数据、生化数据和连续血糖监测系统数据。从连续血糖监测系统数据中得出各种衡量血糖波动的参数。
在纳入的 51 例 2 型糖尿病患者中，排除信息不合格的患者后，对 40 例（每组 20 例）患者的数据进行了分析。两种药物联合治疗均改善了血糖控制。与二甲双胍单药治疗相比，加用阿卡波糖后，血糖波动（以血糖波动幅度的均值或总的日间血糖净效应的均值和日间血糖差异的均值表示）显著降低（均 P<.05），但加用格列本脲后则无此变化。阿卡波糖-二甲双胍联合治疗具有减轻体重和缩短高血糖持续时间的额外益处。
本研究表明，阿卡波糖-二甲双胍联合治疗较格列本脲-二甲双胍联合治疗更有效地降低日内和日间血糖波动，同时两种联合治疗方案均可使总体血糖水平同等降低。
