Johnson M, Krosnick A, Carson P, McDade A M, Laraway K
Joslin Center for Diabetes, Saint Barnabas Health Care System, Princeton, New Jersey 08540, USA.
Clin Ther. 1998 Jul-Aug;20(4):691-8. doi: 10.1016/s0149-2918(98)80132-x.
The hyperglycemia, hyperinsulinemia, insulin resistance, and obesity syndrome associated with type 2 diabetes can have debilitating consequences. The biguanide metformin has a mechanism of action that is complementary to those of insulin and the sulfonylureas, suggesting that combination therapy that includes metformin may result in improved glycemic control. The purpose of this retrospective chart review was to determine the effects of adding metformin in an uncontrolled fashion to existing therapy in obese patients with type 2 diabetes who had suboptimal glycemic control and insulin resistance. For the review, the records of 124 patients were divided into two groups: group 1 included 71 patients who were taking insulin with or without a sulfonylurea, and group 2 consisted of 53 patients who were taking a sulfonylurea alone. Metformin was added to patients' existing therapy in conjunction with downward titration of the sulfonylurea and insulin doses. A retrospective chart review was conducted at the end of 6 months for group 1 and at the end of 12 months for group 2 to determine the change from baseline in measures of diabetes control (ie, insulin and sulfonylurea dose, glycated hemoglobin [Hb A1c] value, body mass index [BMI], and lipid profiles). In group 1, the mean insulin dose decreased from 46.4 U/d at baseline to 6.1 U/d at the end of follow-up. Eighty-three percent of the patients were able to discontinue insulin therapy completely. Similarly, group 2 had statistically significant reductions in mean sulfonylurea dose. Both groups also achieved statistically significant reductions in Hb A1c, BMI, and total cholesterol level. The addition of metformin to treatment with insulin or sulfonylureas, either alone or in combination, significantly improved glycemic control and cholesterol levels and promoted weight loss in obese type 2 diabetic patients with insulin resistance. Less than 5% of patients reported mild, transient gastrointestinal side effects, none of which required cessation of metformin therapy. Five patients discontinued metformin due to lack of efficacy.
与2型糖尿病相关的高血糖、高胰岛素血症、胰岛素抵抗和肥胖综合征可能会产生使人衰弱的后果。双胍类药物二甲双胍的作用机制与胰岛素和磺脲类药物互补，这表明包含二甲双胍的联合治疗可能会改善血糖控制。这项回顾性图表审查的目的是确定在血糖控制不佳且存在胰岛素抵抗的肥胖2型糖尿病患者中，以不受控制的方式将二甲双胍添加到现有治疗中的效果。在此次审查中，124例患者的记录被分为两组：第1组包括71例正在使用胰岛素（联合或不联合磺脲类药物）的患者，第2组由53例仅使用磺脲类药物的患者组成。在降低磺脲类药物和胰岛素剂量的同时，将二甲双胍添加到患者的现有治疗中。在第1组6个月结束时和第2组12个月结束时进行了回顾性图表审查，以确定糖尿病控制指标（即胰岛素和磺脲类药物剂量、糖化血红蛋白[Hb A1c]值、体重指数[BMI]和血脂谱）相对于基线的变化。在第1组中，平均胰岛素剂量从基线时的46.4 U/天降至随访结束时的6.1 U/天。83%的患者能够完全停用胰岛素治疗。同样，第2组的平均磺脲类药物剂量在统计学上有显著降低。两组的Hb A1c、BMI和总胆固醇水平在统计学上也都有显著降低。在胰岛素或磺脲类药物治疗中单独或联合添加二甲双胍，可显著改善肥胖的胰岛素抵抗2型糖尿病患者的血糖控制和胆固醇水平，并促进体重减轻。不到5%的患者报告有轻微、短暂的胃肠道副作用，且无一例需要停用二甲双胍治疗。5例患者因缺乏疗效而停用二甲双胍。
