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选择有DM酮症倾向的成年DM患者,以先胰岛素治疗待酮症消除后改用口服降糖药治疗,其他病人均选择口服降糖药治疗(优降糖、二甲双胍、拜唐苹),使DM病情控制达标(HbA1c<7.0、FPG<7.0mmol/L、2hPG<10.0mmol/L),病情控制不达标者改用胰岛素治疗。结果:(1)口服降糖药治疗达标者为51例(51/57,89.47%)。(2)治疗前两组病人的FPG、2hPG及HbA1c的差异无显著性,但口服药治疗不达标者C肽水平更低,治疗后这种差异仍然存在。(3)与治疗前比较,口服药治疗达标者,治疗后血C肽水平及HbA1c水平均显著改善,差异有显著性(P<0.01)。结论:初诊有酮症倾向的成人DM拒绝使用胰岛素治疗者,使用口服降糖药(可酌情联用优降糖、二甲双胍、拜唐苹)治疗可使90%的患者病情控制达标,而且这种疗效可维护在1年左右,患者的β细胞胰岛素分泌功能改善。
Select DM ketosis tend to adult DM patients treated with insulin therapy before ketosis to oral hypoglycemic agents, other patients were treated with oral hypoglycemic agents (glyburide, metformin, Baitang Ping), so that DM disease control compliance (HbA1c <7.0, FPG <7.0mmol / L, 2hPG <10.0mmol / L), the disease control does not meet the standard switch to insulin treatment. Results: (1) 51 cases (51 / 57,89.47%) were treated with oral hypoglycemic agents. (2) There were no significant differences in FPG, 2hPG and HbA1c between the two groups before treatment, but the level of C-peptide in patients who did not meet the standard of oral medication was lower. This difference still existed after treatment. (3) Compared with those before treatment, the level of serum C-peptide and the level of HbA1c in treatment group were significantly improved after oral administration, the difference was significant (P <0.01). CONCLUSION: In adults with newly diagnosed ketosis, adults with DM predominantly refuse insulin therapy and control of 90% of patients with oral hypoglycemic agents (with glyburide, metformin and beitidine, when appropriate) Efficacy can be maintained in about 1 year, the patient’s β-cell insulin secretion improved.