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| Effect of dipeptidyl peptidase Ⅳ inhibitor on blood glucose fluctuation in patients with brittle diabetes mellitus by dynamic blood glucose monitoring system |
| LI Zhenghan XU Binhua▲ WANG Jing WANG Wei |
| Department of Endocrinology, the First Hospital of Harbin City, Heilongjiang Province, Harbin 150010, China |
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Abstract Objective To observe the effect of dipeptidyl peptidase Ⅳ (DPP-4) inhibitor on blood glucose fluctuation in patients with brittle diabetes mellitus by dynamic blood glucose monitoring system. Methods 72 cases of outpatient and hospitalized patients with brittle diabetes from May 2013 to October 2016 in the First Hospital of Harbin City were selected, all patients enrolled after giving four intensive insulin (Insulin Aspart/Insulin Lispro + Glargine Insulin/Insulin Detemir) treatment, then continuously monitored the blood glucose of the patients with CGMS for 3 days. After 3 days, the patients were divided into DPP-4 group and control group by random number table method, each group of 36 cases. The above hypoglycemic scheme was continued to use in control group, Shah Glenn Dean 5 mg/d was used in DPP-4 group on the basis of control group. All patients were continuously monitored with CGMS before grouping, 1-3 days after grouping and 13-15 days after grouping. Blood glucose fluctuation [mean blood glucose fluctuation range (MAGE), standard deviation of blood glucose level (SDBG), maximum blood glucose fluctuation range (LAGE), mean blood glucose level (MBG), blood glucose> 10.0 mmol/L time percentage (PT10.0), blood glucose <3.9 mmol/L time percentage (PT3.9)], the amount of insulin and C peptide level between two groups were compared. Results Intra-group comparison: after grouping of 1-3 d, MAGE, MBG, LAGE, PT10.0 and PT3.9 of DPP-4 group were lower than before grouping (P < 0.05); after grouping of 13-15 d, the indicators of blood glucose fluctuations in DPP-4 group were lower than before grouping (P < 0.01); there were no significant differences on blood glucose fluctuation indexes before grouping and after grouping of 1-3 d in control group (P > 0.05); after grouping of 13-15 d, MBG, LAGE, PT10.0 in control group were lower than before grouping (P < 0.05). Comparison among groups: after grouping of 1-3 d, MAGE, LAGE, PT10.0 of DPP-4 group were lower than those of control group (P < 0.05); after grouping of 13-15 d, the indicators of blood glucose fluctuations in DPP-4 group were lower than those in control group (P < 0.05 or P < 0.01). The dosage of insulin after grouping of 15 d in DPP-4 group was significantly lower than before grouping (P < 0.01). There was a statistically significant difference on the amount of insulin between two groups after grouping of 15 d (P < 0.01). There was no significant difference on FC-P before and after grouping between two groups both intra-group comparison and comparison among groups (P > 0.05). Conclusion Shah Glenn Dean combined with insulin four times can improve blood glucose fluctuation in patients with fragile diabetes.
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