[Clinical observation on the combined therapy of sitagliptin with insulin for patients with brittle diabetes].

To observe the clinical efficacy of sitagliptin plus insulin on patients with brittle diabetes and to determine the effect of the combined therapy on glucagon secretion. This randomized, double-blinded and placebo-controlled trial included 30 patients with brittle diabetes. Participants were randomly assigned (1:1) to receive the treatment of either sitagliptin plus insulin or placebo plus insulin for 12 weeks. The blood glucose, hemoglobin A1c, insulin dose, C-peptide, glucagon, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP) and other parameters were determined. After 12 weeks of treatment, blood glucose was controlled better by sitagliptin plus insulin (P<0.01). The patients had significantly lower glucose variability indices, lower daily insulin requirement and hemoglobin A1c in the group of sitagliptin plus insulin (P<0.01). After steamed bun test, past-meal GLP-1 levels at 30 min were higher (P<0.01) while GIP levels were lower (P<0.01), with glucagon suppression in the sitagliptin plus insulin group. No significant change was observed at any time point in placebo plus insulin group. Sitagliptin significantly decreases blood glucose level and blood glucose fluctuation, which may contribute to the ability of sitagliptin in decreasing glucagon secretion.目的：观察西格列汀联合胰岛素治疗脆性糖尿病的临床疗效以及二者联合治疗对胰高血糖素的影响。方法：对30例脆性糖尿病患者进行1:1随机双盲分组，分为西格列汀联合胰岛素组和安慰剂联合胰岛素组，治疗12周，观察治疗后患者的血糖控制、血糖波动、糖化血红蛋白、胰岛素剂量、C肽、胰高血糖素、胰高血糖素样肽-1 (glucagon-like peptide-1，GLP-1)和葡萄糖依赖性促胰岛素肽(glucose-dependent insulinotropic polypeptide，GIP)水平等指标的变化。结果：治疗脆性糖尿病患者12周后，西格列汀联合胰岛素组血糖控制的水平和达标率明显优于治疗前和安慰剂联合胰岛素组(P<0.01)；胰岛素用量和糖化血红蛋白较治疗前和安慰剂联合胰岛素组明显减少(P<0.01)；行馒头餐试验，餐后30 min西格列汀联合胰岛素组的胰高血糖素和GIP水平明显低于治疗前和安慰剂联合胰岛素组(P<0.01)，而GLP-1(60 min)水平较治疗前和安慰剂联合胰岛素组升高(P<0.05)。安慰剂联合胰岛素组各指标在治疗前后比较，差异无统计学意义(P>0.05)。结论：在加用西格列汀后，能够更好地控制脆性糖尿病患者血糖和降低血糖波动的幅度；可能是通过降低餐后胰高血糖素水平来稳定脆性糖尿病患者的血糖水平。.