Arai Keiko, Maeda Hajime, Shirabe Shin-ichiro, Yamamoto Ritsuko, Kumakura Atsushi, Yamauchi Mikio, Hirao Tetsuyuki, Hirao Setsuko, Hirao Koichi
1 Arai Clinic , Yokohama, Japan .
Diabetes Technol Ther. 2014 Jul;16(7):442-6. doi: 10.1089/dia.2013.0310. Epub 2014 Feb 14.
In a previous single-center, open-label randomized 3-month study of triple oral antidiabetes drug (OAD) therapy, we investigated factors affecting the glycemic control afforded by sitagliptin, high-dose metformin, and low-dose glimepiride. Patients were prospectively assigned to either Group 1 (50% reduction in metformin) or Group 2 (discontinuation of glimepiride) and compared. The results showed that the glycated hemoglobin (HbA1c) levels of patients in Group 2 deteriorated more than those in Group 1, whereas HbA1c levels were maintained in some patients in both groups.
To determine the factors associated with maintenance of HbA1c under this triple OAD regimen, data from the prospective study were further analyzed.
In both Groups 1 and 2, the baseline HbA1c level was higher in patients with HbA1c ≥7.0% after 3 months of treatment than those with an HbA1c level of <7.0%. A generalized linear model revealed that high-dose metformin was associated with a deterioration of HbA1c levels in Group 2.
Together, the findings indicate that glimepiride and high-dose metformin are important for sustained glycemic control in triple OAD therapy with sitagliptin, metformin, and sulfonylurea.
在先前一项为期3个月的单中心、开放标签的三联口服抗糖尿病药物（OAD）治疗随机研究中，我们调查了影响西他列汀、高剂量二甲双胍和低剂量格列美脲血糖控制的因素。患者被前瞻性地分为第1组（二甲双胍剂量减半）或第2组（停用格列美脲）并进行比较。结果显示，第2组患者的糖化血红蛋白（HbA1c）水平恶化程度高于第1组，而两组中部分患者的HbA1c水平得以维持。
为确定在此三联OAD治疗方案下与HbA1c维持相关的因素，对前瞻性研究的数据进行了进一步分析。
在第1组和第2组中，治疗3个月后HbA1c≥7.0%的患者基线HbA1c水平高于HbA1c水平<7.0%的患者。广义线性模型显示，高剂量二甲双胍与第2组HbA1c水平恶化相关。
总之，研究结果表明，在西他列汀、二甲双胍和磺脲类药物的三联OAD治疗中，格列美脲和高剂量二甲双胍对持续血糖控制很重要。
