沙格列汀联合达格列净治疗老年2型糖尿病疗效观察

Observation of the curative effect of saxagliptin combined with dapagliflozin in the treatment of elderly type 2 diabetes

目的本研究探讨沙格列汀联合达格列净治疗老年2型糖尿病的有效性与安全性,以优化老年2型糖尿病治疗方案。方法选取本院2017-01-12-2018-10-15收治的240例老年2型糖尿病患者为研究对象,根据组间均衡可比的原则,将患者分为沙格列汀组、达格列净组和联合组,各80例。患者均使用二甲双胍进行4周的导入期治疗;导入期治疗结束后,沙格列汀组给予沙格列汀口服,达格列净组给予达格列净口服,联合组给予两药联合口服。记录患者不良反应发生情况,持续治疗12周,评估并对比3组临床疗效;对比治疗前和治疗后3组血生化指标与肾功能指标。结果治疗后,沙格列汀组、达格列净组和联合组临床有效率分别为81.25%、82.50%和95.00%,联合组高于其他两组,差异有统计学意义,χ2=11.136,P<0.001。治疗后,沙格列汀组、达格列净组和联合组空腹血糖(FBG)分别为(6.24±0.56)、(6.37±0.62)和(5.88±0.51)mmol/L,F=16.143,P=0.001;餐后2h血糖(PBG)分别为(8.92±1.01)、(9.02±1.11)和(7.85±0.96)mmol/L,F=31.808,P=0.001;糖化血红蛋白(HbA1c)分别为(6.79±0.31)、(6.87±0.32)和(6.19±0.27)%,F=125.055,P=0.001;稳态模型胰岛素抵抗指数(HOMA-IR)分别为2.56±0.34、2.49±0.37和2.18±0.14,F=36.075,P=0.001;空腹胰岛素水平分别为(8.80±1.31)、(8.78±1.26)和(9.71±1.32)U/L,F=13.423,P=0.001。治疗后,沙格列汀组、达格列净组和联合组血肌酐(Scr)分别为(145.14±20.11)、(144.87±19.41)和(112.98±14.54)μmol/L,F=82.667,P<0.001;尿酸(UA)分别为(364.56±34.79)、(366.02±35.61)和(313.14±32.45)μmol/L,F=61.646,P<0.001;血尿素氮(BUN)水平分别为(11.31±1.24)、(11.42±1.19)和(8.29±1.03)mmol/L,F=188.606,P<0.001。3组治疗期间均有不同程度不良反应发生,但组间比较差异无统计学意义,χ2=1.120,P=0.571。结论沙格列汀联合达格列净治疗老年2型糖尿病,血糖控制效果较药物单用好,患者肾功能明显改善,且联合治疗不会增加不良反应风险,安全性好。

Objective This study aimed to explore the effectiveness and safety of saxagliptin combined with dapagliflozin in the treatment of elderly type 2 diabetes,in order to optimize the treatment plan for elderly type 2 diabetes.Methods A total of 240 elderly patients with type 2 diabetes who were admitted to our hospital from January 12,2017 to October 15,2018 were selected as the research objects.According to the principle of balance and comparability between groups,the patients were divided into saxagliptin group and dapagliflozin group and combination group,each with 80 cases.All patients were treated with metformin during the lead-in period for 4 weeks.After the lead-in period,the saxagliptin group was given saxagliptin orally,the dapagliflozin group was given dapagliflozin orally,the combination group was given two drugs combined orally.The patient’s adverse reactions were recorded and the treatment lasted for 12 weeks.The clinical efficacy of the 3 groups was evaluated and compared.The blood biochemical indexes and renal function indexes of the3 groups were compared before and after treatment.Results After treatment,the clinical effective rates of saxagliptin group,dapagliflozin group and combination group were 81.25%,82.50%and 95.00%,the combination group was higher than the other two groups,the difference was statistically significant,χ2=11.136,P<0.001.After treatment,the fasting blood glucose(FBG)of saxagliptin group,dapagliflozin group and combination group were(6.24±0.56),(6.37±0.62)and(5.88±0.51)mmol/L,F=16.143,P=0.001.The 2 hpostprandial blood glucose(PBG)were(8.92±1.01),(9.02±1.11)and(7.85±0.96)mmol/L,F=31.808,P=0.001.Glycosylated hemoglobin(HbA1 c)were(6.79±0.31),(6.87±0.32)and(6.19±0.27)%,F=125.055,P=0.001.Steady state model insulin resistance index(HOMA-IR)were 2.56±0.34,2.49±0.37 and 2.18±0.14,F=36.075,P=0.001.Fasting insulin levels were(8.80±1.31),(8.78±1.26)and(9.71±1.32)U/L,F=13.423,P=0.001.After treatment,the blood creatinine(Scr)of saxagliptin group,dapagliflozin group and combination group were(145.14±20.11),(144.87±19.41)and(112.98±14.54)μmol/L,F=82.667,P<0.001.Uric acid(UA)were(364.56±34.79),(366.02±35.61)and(313.14±32.45)μmol/L,F=61.646,P<0.001.Blood urea nitrogen(BUN)levels were(11.31±1.24),(11.42±1.19)and(8.29±1.03)mmol/L,F=188.606,P<0.001.During the treatment period,the three groups all had different degrees of adverse reactions,but the difference between the groups was not statistically significant,χ2=1.120,P=0.571.Conclusions Saxagliptin combined with dapagliflozin in the treatment of elderly type 2 diabetes has a better blood glucose control effect than drug alone,and the renal function of patients is significantly improved.The combined treatment does not increase the risk of adverse reactions and is safe.