胰岛素联合达格列净治疗2型糖尿病临床疗效分析

The clinical effect of insulin combined with dapagliflozinin treatment of patients with type 2 diabetes mellitus

目的:探讨胰岛素治疗血糖控制不佳的2型糖尿病(T2DM)患者加用达格列净治疗后的效果及对代谢指标的影响。方法:收集使用胰岛素强化治疗后血糖控制仍不达标的2型糖尿病患者20例,胰岛素使用剂量大于60 U/d。口服达格列净片10 mg,1次/d,并个体化给予减少胰岛素剂量治疗20周后,测量体质量、体质量指数(BMI)、低密度脂蛋白(LDL)、尿微量白蛋白、甘油三酯(TG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、空腹血糖(FBG)、餐后2 h血糖(2hPG),记录胰岛素剂量,观察上述指标水平与服用达格列净前的基线水平比较变化情况。结果:加入达格列净治疗20周后,体质量、BMI、尿微量白蛋白、TC、TG、LDL、FBG、2hPG、胰岛素剂量均下降(P<0.05)。20例联合使用达格列净治疗的患者未出现泌尿系感染,3例患者使用初期有明显口干、多尿症状,未停药1周后口干、多尿症状逐渐消失。在结合血糖水平及时调整胰岛素剂量情况下,未出现低血糖事件。结论:在大剂量胰岛素治疗后血糖控制仍不达标的2型糖尿病患者,使用达格列净可减少胰岛素剂量,在控制血糖的同时降低体重,无明显低血糖风险,提示联合达格列净治疗方案优于单纯大剂量胰岛素治疗。

Objective:To analyze the effect of insulin combined with dapagliflozin in treatment of type 2 diabetes patients with poor blood glucose control and its effect on metabolic indexes.Methods:20 type 2 diabetes patients who had poor blood glucose control after receiving intensive insulin therapy were included.The insulin dose was more than 60 U/d.The body weight,BMI,TC,TG,LDL,urinary microalbumin,HbA1 c,FBG,2 hPG were measured and insulin dosage was recorded after taking dapagliflozin 10 mg orally once a day and individualized insulin dosage reduction for 20 weeks.The changes of the above indexes were compared with the baseline level before the administration of dapagliflozin.Results:After 20 weeks of dapagliflozin treatment,the body weight,BMI,urinary microalbumin,TC,TG,LDL,FBG,2 hPG and insulin dosage were significantly decreased(P<0.05).There was no urinary tract infection in 20 patients treated with dapagliflozin.The symptoms of dry mouth and polyuria were obvious in 3 patients at the initial stage of use and disappeared gradually one week after the drug was not stopped.There was no hypoglycemic event when the insulin dosage was adjusted in time in combination with the blood glucose level.Conclusion:In type 2 diabetes patients who have poor blood glucose control after high-dose insulin treatment,dapagliflozin can significantly reduce the dosage of insulin,effectively control blood glucose and significantly reduce weight,with no significant risk of hypoglycemia.It is suggested that the combination of dapagliflozin therapy is superior to high dose insulin therapy.