目的 探討二甲雙胍聯(lián)合優(yōu)泌林治療初發(fā)糖尿病病足的肥胖2型糖尿病的療效。方法 選取2010年1月-2013年1月上海市嘉定區(qū)安亭醫(yī)院就診的初發(fā)糖尿病足的肥胖2型糖尿患者80例，隨機(jī)分為治療組與對照組，每組40例。兩組患者均口服二甲雙胍1.5 g/d。治療組在口服二甲雙胍的同時(shí)，注射優(yōu)泌林，起始劑量早15 U/d、晚10 U/d，嚴(yán)密監(jiān)測血糖，如沒有出現(xiàn)低血糖的癥狀，逐漸加量至早40 U/d、晚30 U/d。觀察比較兩組患者治療前及治療12周后的糖化血紅蛋白（HbAlC）、空腹血糖（FBG），并測量計(jì)算治療前后患者的踝肱指數(shù)（ABI）、餐后2 h血糖（2hPBG）、體質(zhì)量指數(shù)（BMI）。同時(shí)于治療12周后觀察詢問患者足部病變?nèi)绺稍?、皸裂、足癬以及胼胝的改善情況。結(jié)果 治療12周后，兩組患者的ABI均高于治療前，并且治療組高于對照組，差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。而兩組患者的HbAlC、FBG、2hPBG和BMI均低于治療前，并且治療組低于對照組，差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。同時(shí)兩組患者的足部病變改善情況均優(yōu)于治療前，并且治療組患者的足部病變改善情況明顯優(yōu)于對照組（P<0.05）。結(jié)論 二甲雙胍聯(lián)合優(yōu)泌林的治療對于初發(fā)糖尿病足的肥胖2型糖尿病患者的足部血管改善、足部病變恢復(fù)及血糖控制具有更好的效果，推薦臨床使用。

Objective To explore the efficacy of metformin combined with Humulin in the treatment of obese type 2 diabetes with onset diabetic foot. Methods Obese type 2 diabetic patients (80 cases) with onset diabetic foot, who came to Anting Hospital of Shanghai Jiading District from January 2010 to January 2013 for the treatment, were randomly divided into treatment and control groups (40 cases in each group). The patients in the both groups were given metformin 1.5 g/d. The patients in the treatment group were given metformin combined with Humulin, the starting dose was 15 U/d in the morning, and 10 U/d in the evening. The blood sugar was closely monitored, if there was not the symptom of hypoglycemia, the amount to 40 U/d was gradually added in the morning, and 30 U/d in the evening. The hemoglobin (HbAlC), fasting blood glucose (FBG), 2 h postprandial blood glucose (2hPBG), body mass index (BMI), ankle-brachial index (ABI), and the improvement of foot lesions between the two groups were compared before and 12 weeks after the therapy. Results After 12 weeks of the treatment, ABI was significantly higher than that in the same group before the treatment, and the differences between the two groups was statistically significant (P< 0.05). HbAlC, FBG, 2hPBG, and BMI were lower than those in the same group before the treatment. And there were the significant differences between the two groups (P< 0.05). The improvement of foot lesions was better than that in the same group before the treatment, and the differences between the two groups were statistically significant (P< 0.05). Conclusion Metformin combined with Humulin could be better in the control of blood glucose and the improvement of blood supply and foot lesions of obese type 2 diabetic patients with onset diabetic foot. It is worth of clinic application.

上海市嘉定區(qū)科學(xué)技術(shù)發(fā)展資助項(xiàng)目（2012-18）