Fanghänel G, Sánchez-Reyes L, Trujillo C, Sotres D, Espinosa-Campos J
Endocrinology Service, General Hospital of Mexico, Mexico City.
Diabetes Care. 1996 Nov;19(11):1185-9. doi: 10.2337/diacare.19.11.1185.
To compare results obtained with metformin versus those obtained with DNA-recombinant insulin in obese patients with NIDDM suffering from secondary failure to sulfonylureas.
We conducted an open, prospective, randomized, and comparative study comprising a total of 60 patients selected and placed in two parallel groups. We had previously confirmed that the subjects had secondary failure to high doses of sulfonylureas. The initial metformin dosage was a single 850 mg tablet, and the dosage was increased to two or three tablets depending on the patient's metabolic changes. The initial dosage of DNA-recombinant insulin was 24 U, subcutaneously administered and divided into two portions: two-thirds at around 8:00 A.M., before breakfast, and the remaining third at 8:00 P.M., before dinner. The dosage was adjusted based on the patient's clinical and metabolic response.
The initial average glucose value for the metformin group was 269.1 +/- 32.2 mg/dl, decreasing by the end of the study to 159.7 +/- 30.5 mg/dl. For the insulin group, these figures went from 270.7 +/- 24.0 mg/dl at the beginning of the study to 134.8 +/- 26.7 mg/dl. This decrease correlates with the reduction in glycosylated hemoglobin from 12.8 to 8.9% for the first group and from 12.3 to 8.2% for the second, as well as with the reduction in triglyceride values from 230.3 to 183.1 mg/dl and from 218.4 to 186.3 mg/dl, respectively. The BMI (27.5-26.4), blood pressure (systolic from 145.7-132.1 mmHg, diastolic from 90.3-84.8 mmHg), and total cholesterol levels (235-202 mg/dl) decreased in only the metformin group.
Metformin is an effective, safe, and well-tolerated treatment that improves metabolic control and favorably modifies secondary clinical alterations due to insulin resistance, such as arterial hypertension, overweight, and hyperlipidemia, in obese patients with NIDDM suffering from secondary failure to sulfonylureas.
比较二甲双胍与重组DNA胰岛素对磺脲类药物继发失效的肥胖非胰岛素依赖型糖尿病（NIDDM）患者的治疗效果。
我们进行了一项开放、前瞻性、随机对照研究，共选取60例患者并分为两个平行组。我们之前已确认这些受试者对高剂量磺脲类药物继发失效。二甲双胍初始剂量为1片850毫克，根据患者代谢变化将剂量增至2片或3片。重组DNA胰岛素初始剂量为24单位，皮下注射，分两次给药：早餐前8点左右注射三分之二，晚餐前8点注射剩余三分之一。根据患者临床和代谢反应调整剂量。
二甲双胍组初始平均血糖值为269.1±32.2毫克/分升，研究结束时降至159.7±30.5毫克/分升。胰岛素组这些数值从研究开始时的270.7±24.毫克/分升降至134.8±26.7毫克/分升。这种下降与糖化血红蛋白的降低相关，第一组从12.8%降至8.9%，第二组从12.3%降至8.2%，同时甘油三酯值也分别从230.3毫克/分升降至183.1毫克/分升以及从218.4毫克/分升降至186.3毫克/分升。仅二甲双胍组的体重指数（27.5 - 26.4）、血压（收缩压从145.7 - 132.1毫米汞柱，舒张压从90.3 - 84.8毫米汞柱）和总胆固醇水平（235 - 202毫克/分升）有所下降。
对于磺脲类药物继发失效的肥胖NIDDM患者，二甲双胍是一种有效、安全且耐受性良好的治疗方法，可改善代谢控制，并对因胰岛素抵抗引起的继发性临床改变（如动脉高血压、超重和高脂血症）产生有益影响。
