Bayraktar M, Van Thiel D H, Adalar N
Department of Endocrinology, Hacettepe University, Ankara, Turkey.
Diabetes Care. 1996 Mar;19(3):252-4. doi: 10.2337/diacare.19.3.252.
To compare the effects of acarbose or metformin treatment used as an adjunct with a sulfonylurea agent in the treatment of NIDDM not adequately controlled with the use of a sulfonylurea agent alone.
Of the poorly controlled female NIDDM patients on sulfonylurea treatment, 18 were randomly selected from the outpatient diabetic clinic for study. For 8 weeks, they received either acarbose (300 mg/daily) or metformin (1,500 mg/daily) in addition to sulfonylurea in a crossover design using a 3-week washout period between treatments. The efficacy of each drug regimen was assessed by measuring the levels of glycosylated hemoglobin, fasting and 2-h postprandial blood glucose (PPBG) levels, cholesterol, triglyceride, and fibrinogen levels before and after 8 weeks of therapy.
The metabolic parameters measured before initiation of either treatment regimen were similar. Mean fasting and 2-h postprandial glucose levels were reduced moderately at the end of 8 weeks of both combination treatments (P < 0.05). Although the fasting and 2-h postprandial plasma insulin and C-peptide and fibrinogen levels at the end of the 8-week treatment periods were lower than those obtained at the beginning of the study, the differences between these values were not statistically significant. Cholesterol levels remained unchanged. Only the 2-h PPBG level in the group using acarbose plus a sulfonylurea was lower than the level achieved by the group using metformin plus a sulfonylurea (8.1 +/- 0.8 vs. 9.8 +/- 1.0 mmol/l, respectively, P < 0.05). The difference between pre- and posttreatment levels of the 2-h PPBG level in both arms of the study were statistically significant (delta-acarbose, 5.3 +/- 0.4 vs. delta-metformin, 2.9 +/- 0.3) (P < 0.05). Specific drug-associated side effects were observed in 12 patients on acarbose and 3 patients on metformin.
Acarbose or metformin can be used as effective adjuvant therapies with a sulfonylurea agent in NIDDM patients who are poorly controlled with the sulfonylurea agent alone.
比较单独使用磺脲类药物治疗效果欠佳的非胰岛素依赖型糖尿病（NIDDM）患者，加用阿卡波糖或二甲双胍作为辅助治疗的效果。
从门诊糖尿病诊所中，随机选取18名接受磺脲类药物治疗但病情控制不佳的女性NIDDM患者进行研究。在为期8周的时间里，她们采用交叉设计，在每次治疗之间设置3周的洗脱期，除磺脲类药物外，分别接受阿卡波糖（300毫克/每日）或二甲双胍（1500毫克/每日）治疗。通过测量糖化血红蛋白水平、空腹及餐后2小时血糖（PPBG）水平、胆固醇、甘油三酯和纤维蛋白原水平，在治疗8周前后评估每种药物治疗方案的疗效。
在开始任何一种治疗方案之前所测量的代谢参数相似。两种联合治疗在8周结束时，平均空腹及餐后2小时血糖水平均有适度降低（P < 0.05）。虽然在8周治疗期结束时，空腹及餐后2小时血浆胰岛素、C肽和纤维蛋白原水平低于研究开始时，但这些值之间的差异无统计学意义。胆固醇水平保持不变。仅使用阿卡波糖加磺脲类药物组的餐后2小时PPBG水平低于使用二甲双胍加磺脲类药物组（分别为8.1±0.8与9.8±1.0毫摩尔/升，P < 0.05）。研究的两个组中，餐后2小时PPBG水平治疗前后的差异均有统计学意义（阿卡波糖组，5.3±0.4与二甲双胍组，2.9±0.3）（P < 0.05）。观察到12名服用阿卡波糖的患者和3名服用二甲双胍的患者出现了特定的药物相关副作用。
对于单独使用磺脲类药物控制不佳的NIDDM患者，阿卡波糖或二甲双胍可作为有效的辅助治疗药物与磺脲类药物联合使用。
