度拉糖肽和利拉鲁肽联合二甲双胍治疗超重及肥胖2型糖尿病的比较研究

Comparative study on dulaglutide and liraglutide combined with metformin in treatment of overweight and obesity type 2 diabetes mellitus

目的比较度拉糖肽注射液和利拉鲁注射液肽联合盐酸二甲双胍片治疗超重及肥胖2型糖尿病患者的临床疗效。方法选择2019年8月—2020年8月就诊于天津市第二医院门诊的68例超重及肥胖2型糖尿病患者,采用随机数字表法将所有患者分为对照组和治疗组,每组各34例。所有患者口服盐酸二甲双胍片,1500mg/d。对照组给予利拉鲁肽注射液,起始剂量为每日7:00皮下注射0.6mg,根据血糖水平和患者的反应逐步增加剂量,最大剂量为1.8mg/d。治疗组给予度拉糖肽注射液,起始剂量为每10天于7:00皮下注射度拉糖肽注射液1.5 mg,根据血糖和患者的耐受情况逐步调整为每周固定一天7:00皮下注射度拉糖肽注射液1.5 mg。两组患者连续治疗24周。观察两组患者的临床疗效,比较两组患者治疗前后的血糖、糖化血红蛋白(HbA1c)、体质量指数(BMI)、胰岛素抵抗指数(HOMA-IR)的变化。结果治疗后,对照组和治疗组总有效率分别为94.12%、97.06%,治疗组总有效率高于对照组,但两组总有效率比较差异无统计学意义。治疗后,两组空腹血糖(FPG)、餐后2小时血糖(2 h PPG)、HbA1c、BMI均显著低于治疗前(P<0.05);治疗后两组FPG、2 h PPG、HbA1c、BMI比较差异无统计学意义。治疗后,两组HOMA-IR均低于治疗前,差异有统计学意义(P<0.05);治疗后两组HOMA-IR比较差异无统计学意义。两组间HOMA-IR下降值比较无统计学差异。结论度拉糖肽注射液和利拉鲁肽注射液联合盐酸二甲双胍片治疗超重及肥胖2型糖尿病的疗效显著,降糖同时减重,改善胰岛素抵抗,值得推广。

Objective To compare the efficacy of Dulaglutide Injection and Liraglutide Injection combined with Metformin Hydrochloride Tablets in treatment of overweight and obesity type 2 diabetes mellitus. Methods Patients(68 cases) with overweight and obesity type 2 diabetes mellitus in Tianjin Second Hospital from August 2019 to August 2020 were randomly divided into control and treatment groups, and each group had 34 cases. All patients were po administered with Metformin Hydrochloride Tablets, 1 500 mg/d. Patients in the control group were given Liraglutide Injection, the initial dose was subcutaneous injection of 0.6 mg at 7:00 daily, the dose was gradually increased according to the blood glucose level and the patient’s reaction, and the maximum dose was 1.8 mg/d. Patients in the treatment group were given Dulaglutide Injection, and the initial dose was subcutaneous injection of 1.5 mg at 7:00 every 10 days. According to the blood glucose and tolerance of patients, it was gradually adjusted to subcutaneous injection of 1.5 mg at 7:00 every week. Patients in two groups were treated for 24 weeks. After treatment, the clinical efficacies were evaluated, and the changes of blood glucose, HbA1 c, BMI, and HOMA-IR were compared between the two groups before and after treatment. Results After treatment, the total effective rates of the control group and the treatment group were 94.12% and 97.06%, respectively, and there was no significant difference between the two groups. After treatment, the FPG, 2 h PPG, HbA1 c, and BMI of two groups were significantly lower than those before treatment(P < 0.05). There was no significant difference in FPG, 2 h PPG, HbA1 c, and BMI between two groups after treatment. After treatment, the HOMA-IR of two groups was lower than before treatment, and the difference was statistically significant(P < 0.05). There was no significant difference in HOMA-IR between two groups after treatment. There was no significant difference in the decrease of HOMA-IR between two groups. Conclusion Dulaglutide Injection and Liraglutide Injection combined with Metformin Hydrochloride Tablets has clinical effect in treatment of overweight and obesity type 2 diabetes mellitus, can reduce blood sugar and weight, improve insulin resistance, which is worthy of promotion.