达格列净联合胰岛素治疗超重/肥胖及胰岛功能受损且血糖控制不佳的2型糖尿病患者的效果

Effect of Dapagliflozin Combined with Insulin in the Treatment of Type 2 Diabetes Mellitus Patients with Overweight/Obesity,Impaired Islet Function and Poor Glycemic Control

目的:探讨达格列净联合胰岛素在超重/肥胖及胰岛素功能受损且血糖控制不佳的2型糖尿病患者中的临床效果。方法:选择2019年10月-2020年9月本院就诊的超重/肥胖及胰岛素功能受损且血糖控制不佳的2型糖尿病患者114例作为研究对象。按照随机数字表法分为对照组和观察组,各57例。对照组采用胰岛素治疗,观察组在对照组基础上联合达格列净治疗。治疗4周对两组治疗效果进行评估,比较两组胰岛素使用剂量、空腹血糖(FPG)、餐后2 h血糖(2 h PBG)、糖化血红蛋白(HbA1c)、胰岛素分泌指数(HOMA-β)、胰岛素敏感指数(ISI)及并发症。结果:治疗后1、2、4周,观察组胰岛素使用剂量明显低于治疗前(P<0.05),观察组胰岛素使用剂量低于对照组(P<0.05)。治疗后4周,观察组FPG、2 h PBG及HbA1c水平低于对照组,HOMA-β及ISI水平高于对照组(P<0.05)。两组低血糖、肝肾异常、泌尿系感染、真菌感染及鼻咽炎总发生率对比差异无统计学意义(P>0.05)。结论:达格列净联合胰岛素用于超重/肥胖及胰岛素功能受损且血糖控制不佳的2型糖尿病患者中能减少胰岛素使用剂量,降低患者血糖水平,增强胰岛素敏感性,未增加并发症发生率,值得推广应用。

Objective:To investigate the clinical effect of Dapagliflozin combined with Insulin in overweight/obesity patients with impaired insulin function and poor glycemic control.Method:A total of 114 type 2 diabetes patients with overweight/obesity,impaired insulin function and poor blood glucose control in our hospital from October 2019 to September 2020 were selected as the study objects.They were divided into the control group and the observation group according to random number table method,57 cases in each group.The control group was treated with Insulin;on the basis of the control group,the observation group was treated with Dapagliflozin.After 4 weeks of treatment,the effects of the two groups were evaluated.The Insulin dosage,fasting blood glucose (FPG),2 h postprandial blood glucose (2 h PBG),glycated hemoglobin (HbA1c),insulin secretion index (HOMA-β),insulin sensitivity index (ISI) and complications were compared between the two groups.Result:At 1,2 and 4 weeks after treatment,the Insulin dosage in the observation group was significantly lower than that before treatment (P<0.05),the Insulin dosage in the observation group was lower than that in the control group (P<0.05).At 4 weeks after treatment,the levels of FPG,2 h PBG and HbA1c in the observation group were lower than those in the control group,while the levels of HOMA-β and ISI in the observation group were higher than those in the control group (P<0.05).There was no significant difference in the total incidence of hypoglycemia,liver and kidney abnormalities,urinary tract infection,fungal infection and nasopharyngitis between the two groups (P>0.05).Conclusion:Dapagliflozin combined with Insulin can reduce the dosage of Insulin,reduce the blood glucose level,enhance the insulin sensitivity,and do not increase the incidence of complications in overweight/obesity patients with impaired insulin function and poor glycemic control,which is worthy of promotion and application.