Du Guoli, Xie Wanrun, Su Yinxia, Ma Yao, Gao Xiaoming, Jiang Sheng, Liang Huazheng
Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumuqi, Xinjiang Uygur Autonomous Region, China.
Health Management Center, The First Affiliated Hospital of Xinjiang Medical University, Urumuqi, Xinjiang Uygur Autonomous Region, China.
PeerJ. 2020 Oct 2;8:e9905. doi: 10.7717/peerj.9905. eCollection 2020.
Acarbose and repaglinide are widely used either by themselves or in combination with other medications. However, their efficacy in diabetes control has not been compared when used in combination with metformin.
The present study aimed to compare their effects on glycemic variability (GV) control when taken with metformin for type 2 diabetes mellitus (T2DM) inadequately controlled with metformin alone. In this retrospective cohort study, T2DM patients who were treated with either acarbose-metformin or repaglinide-metformin combination were recruited. Either acarbose 100 mg or repaglinide 2 mg triple daily was taken for the subsequent 12 weeks in combination with metformin. Demographic data, biochemical data and 7-point glycemic self-monitoring conducted with capillary blood (SMBG) data were reviewed after one week and 12 weeks. The primary outcome including glucose control and changes in GV as well as other factors affecting GV and the incidence of hypoglycemia were also analyzed.
Of the 305 T2DM patients enrolled, data from 273 subjects, 136 in the acarbose-metformin group (M+A) and 137 in the repaglinide-metformin group (M+R) were analyzed. Both regimens improved glycemic control at 12 weeks post commencement of new medications. GV, expressed as the mean amplitude of plasma glycemic excursions (MAGE, 5.0 ± 2.6 vs. 2.8 ± 1.6 mmol/L, < 0.001 in M+A; 5.1 ± 2.5 vs. 2.9 ± 1.3 mmol/L, < 0.001 in M+R), standard deviation of blood glucose (SDBG, 3.6 ± 1.3 vs. 2.0 ± 0.9 mmol/L, < 0.001 in M+A; 3.7 ± 1.3 vs. 2.4 ± 1.3 < 0.001 in M+R), coefficient of variation of blood glucose (CVBG, (0.30 ± 0.09 vs. 0.21 ± 0.1, < 0.001 in M+A; 0.31 ± 0.09 vs. 0.24 ± 0.12, < 0.001 in M+R), postprandial amplitude of glycemic excursions (PPGE, 5.2 ± 2.6 vs. 2.8 ± 1.6 mmol/L, < 0.001 in M+A; 5.3 ± 2.5 vs. 2.9 ± 1.3 mmol/L, < 0.001 in M+R) or largest amplitude of glycemic excursions (LAGE, 9.8 ± 3.6 vs. 5.4 ± 2.4 mmol/L, < 0.001 in M+A; 10.1 ± 3.4 vs. 6.3 ± 3.2 mmol/L, < 0.001 in M+R) decreased significantly after the addition of acarbose or repaglinide ( < 0.05 respectively). Compared with repaglinide-metformin, acarbose-metformin was more effective in GV control at 12 weeks post commencement of new medications ( < 0.05). This study indicates that both acarbose-metformin and repaglinide-metformin combinations could effectively reduce GV and the acarbose-metformin combination seems to be more effective than the repaglinide-metformin combination. However, this conclusion should be confirmed by future large-scaled and more comprehensive studies due to the limitations of the present study.
阿卡波糖和瑞格列奈广泛单独使用或与其他药物联合使用。然而，它们与二甲双胍联合使用时在控制糖尿病方面的疗效尚未得到比较。
本研究旨在比较它们与二甲双胍联合使用时对2型糖尿病（T2DM）患者血糖变异性（GV）的控制效果，这些患者仅使用二甲双胍治疗时血糖控制不佳。在这项回顾性队列研究中，招募了接受阿卡波糖 - 二甲双胍或瑞格列奈 - 二甲双胍联合治疗的T2DM患者。随后12周，每日三次服用100毫克阿卡波糖或2毫克瑞格列奈，并与二甲双胍联合使用。在1周和12周后回顾人口统计学数据、生化数据以及用毛细血管血进行的7点血糖自我监测（SMBG）数据。还分析了主要结局，包括血糖控制、GV变化以及其他影响GV的因素和低血糖发生率。
在纳入的305例T2DM患者中，分析了273例受试者的数据，阿卡波糖 - 二甲双胍组（M + A）136例，瑞格列奈 - 二甲双胍组（M + R）137例。两种治疗方案在开始使用新药物12周后均改善了血糖控制。用血浆血糖波动平均幅度（MAGE，M + A组为5.0±2.6 vs. 2.8±1.6 mmol/L，P < 0.001；M + R组为5.1±2.5 vs. 2.9±1.3 mmol/L，P < 0.001）、血糖标准差（SDBG，M + A组为3.6±1.3 vs. 2.0±0.9 mmol/L，P < 0.001；M + R组为3.7±1.3 vs. 2.4±1.3，P < 0.001）、血糖变异系数（CVBG，M + A组为0.30±0.09 vs. 0.21±0.1，P < 0.001；M + R组为0.31±0.09 vs. 0.24±0.12，P < 0.001）、餐后血糖波动幅度（PPGE，M + A组为5.2±2.6 vs. 2.8±1.6 mmol/L，P < 0.001；M + R组为5.3±2.5 vs. 2.9±1.3 mmol/L，P < 0.001）或最大血糖波动幅度（LAGE，M + A组为9.8±3.6 vs. 5.4±2.4 mmol/L，P < 0.001；M + R组为10.1±3.4 vs. 6.3±3.2 mmol/L，P < 0.001）表示的GV在添加阿卡波糖或瑞格列奈后均显著降低（P均< 0.05）。与瑞格列奈 - 二甲双胍相比，在开始使用新药物12周后，阿卡波糖 - 二甲双胍在控制GV方面更有效（P < 0.05）。本研究表明，阿卡波糖 - 二甲双胍和瑞格列奈 - 二甲双胍联合使用均能有效降低GV，且阿卡波糖 - 二甲双胍联合似乎比瑞格列奈 - 二甲双胍联合更有效。然而，由于本研究的局限性，这一结论应由未来大规模、更全面的研究来证实。
