达格列净联合胰岛素强化治疗难治性2型糖尿病的疗效观察

Effect of dapagliflozin combined with intensive insulin therapy on refractory type 2 diabetes mellitus

目的评价达格列净联合胰岛素强化治疗难治性2型糖尿病的疗效。方法选取2017年7月至2019年7月治疗的90例难治性2型糖尿病患者。随机分为对照组(单纯胰岛素强化治疗)和试验组(达格列净联合胰岛素强化治疗),各45例。两组连续治疗12周,比较治疗前和治疗后两组的胰岛素用量、血糖水平、C肽水平、胰岛素抵抗指数(HOMA-IR)、体质指数(BMI)、血脂、血压、血清尿酸水平(SUA)以及不良反应发生情况。结果治疗前两组各项基线指标差异无统计学意义(P>0.05)。治疗后试验组的胰岛素用量、空腹血糖(FPG)、餐后2小时血糖(2hPBG)、糖化血红蛋白(HbA1c)、C肽、HOMA-IR、BMI、三酰甘油(TG)、血清总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、SUA水平较对照组降低(P<0.05),HDL-C较对照组增高(P<0.05);两组不良反应比较差异无统计学意义(P>0.05)。结论达格列净联合胰岛素强化治疗难治性2型糖尿病,能够显著降低血糖、血尿酸水平及胰岛素抵抗情况,调节血脂,临床效果显著。

Objective To investigate the clinical effect of dapagliflozin combined with intensive insulin therapy on refractory type 2 diabetes mellitus(T2 DM).Methods A total of 90 patients with refractory T2 DM who received treatment from July 2017 to July 2019 were selected and divided into control group(intensive insulin therapy)and experimental group(dapagliflozin+intensive insulin therapy)randomly(n=45,each).All the patients were treated for 12 weeks.Insulin dosage,blood glucose level,C-peptide level,HOMA-IR,BMI,blood lipid,blood pressure,serum uric acid(SUA)level and adverse reactions were compared between the two groups before and after treatment.Results There was no significant difference in baseline indexes between the two groups before treatment(P>0.05).After treatment,insulin dosage,fasting blood glucose(FPG),2-hour postprandial blood glucose(2 hPBG),glycosylated hemoglobin(HbA1 c),C-peptide,HOMA-IR,BMI,triglyceride(TG),serum total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),SUA levels in the experimental group were lower than those in the control group(P<0.05),and high-density lipoprotein cholesterol(HDL-C)was higher than that in control group(P<0.05).There was no significant difference in adverse reactions between the two groups(P>0.05).Conclusion Dapagliflozin combined with intensive insulin therapy of refractory T2 DM can reduce blood glucose,blood uric acid levels and insulin resistance significantly,and it can regulate blood lipids.