目的 探討不同口服降糖藥聯(lián)合胰島素對(duì)糖尿病患者胰島β細(xì)胞功能、骨代謝和成本效果的影響，為臨床治療提供參考依據(jù)。方法 選取西安市第一醫(yī)院2015年3月—2018年3月收治100例糖尿病患者，根據(jù)入院先后順序隨機(jī)分為觀察組和對(duì)照組，每組50例，兩組患者于每晚睡覺(jué)前皮下注射胰島素，起始劑量為0.2 U/（kg·d），并停用其他降糖藥物。觀察組患者在此基礎(chǔ)上，口服沙格列汀片5 mg/次，1次/d。對(duì)照組患者口服格列美脲片1 mg/次，1次/d，兩組均連續(xù)治療12周。對(duì)比兩種不同口服降糖藥物對(duì)糖尿病患者胰島β細(xì)胞功能、骨代謝和成本的影響。結(jié)果 兩組患者治療前胰島β細(xì)胞（Homaβ）、修正胰島β細(xì)胞分泌指數(shù)（MBCI）、早期胰島素分泌指數(shù)（EISI）、血糖曲線(xiàn)下面積（AUCglu）、胰島素曲線(xiàn)下面積（AUCins）和C肽曲線(xiàn)下面積（AUCcp）對(duì)比無(wú)顯著性差異；治療后，兩組的Homaβ、MBCI、EISI、AUCins和AUCcp水平在治療后顯著升高，而AUCglu水平治療后顯著降低，同組治療前后比較差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）；且觀察組治療后Homaβ、MBCI、EISI、AUCins和AUCcp水平顯著高于對(duì)照組，而AUCglu水平顯著低于對(duì)照組，組間差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組患者經(jīng)不同用藥方案治療后的骨密度均明顯改善，與同組治療前相比具有統(tǒng)計(jì)學(xué)差異（P<0.05），而與對(duì)照組相比，觀察組患者的骨密度改善程度更加明顯，組間差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組患者治療后血糖的控制情況空腹血糖（FPG）、餐后2 h血糖（2h PG）和糖化血紅蛋白（HbA1C）比治療前均顯著降低，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；且觀察組治療后FPG、2h PG和HbA1C均顯著低于對(duì)照組治療后（P<0.05）。觀察組患者降糖藥物成本低于對(duì)照組，但兩種治療方案藥物成本對(duì)比無(wú)統(tǒng)計(jì)學(xué)差異。結(jié)論 糖尿病患者采取口服沙格列汀降糖藥物聯(lián)合胰島素治療方案是可行的，可結(jié)合患者具體特點(diǎn)，在早期應(yīng)用藥物，改善患者的胰島β細(xì)胞功能，改善骨代謝，控制血糖水平，延緩糖尿病進(jìn)展，經(jīng)濟(jì)效果較佳，可減輕患者的經(jīng)濟(jì)負(fù)擔(dān)。

Objective To investigate the effects of different oral hypoglycemic drugs combined with insulin on islet beta cell function, bone metabolism and cost-effectiveness in diabetic patients, and to provide reference for clinical treatment.Methods 100 patients with diabetes mellitus were randomly divided into study group and control group according to the order of admission, 50 patients in each group were treated with insulin. On this basis, the study group was treated with sagretine and the control group was treated with glimepiride. The effects of two different oral hypoglycemic drugs on islet beta cell function, bone metabolism and cost in diabetic patients were compared.Results There was no significant difference in Homa beta, MBCI, EISI, AUCglu, AUCins and AUCcp between the two groups before treatment. After treatment, the indexes of the study group were significantly better than those of the control group (P<0.05). The bone mineral density of the two groups were significantly improved after treatment with different drug regimens, compared with before treatment. The bone mineral density of the study group improved more significantly than that of the control group (P<0.05). The control of blood glucose after treatment in both groups was significantly lower than that of FPG, 2h PG and HbA1C after treatment (P<0.05). FPG, 2h PG and HbA1C were significantly lower in the study group than in the control group (P<0.05). The cost of hypoglycemic drugs in the study group was lower than that of the control group, but there was no statistical difference in the cost of the two treatment regimens. Conclusion It is feasible for diabetic patients to take oral saglitine hypoglycemic drugs combined with insulin therapy, which can improve the function of islet beta cells, improve bone metabolism, Control blood sugar levels, delay the progress of diabetes mellitus. The economic effect is better and can be reduced. The economic burden of patients.