DDP-4抑制剂与GLP-1受体激动剂治疗2型糖尿病患者的有效性研究

Study on the effectiveness of DDP-4 inhibitors and GLP-1 receptor agonists in the treatment of patients with type 2 diabetes mellitus

目的探讨二肽基肽酶-4(DDP-4)抑制剂与胰高血糖素样肽-1(GLP-1)受体激动剂治疗2型糖尿病患者的有效性。方法将2019年1月至2020年6月在内分泌科治疗的126例2型糖尿病患者随机分为对照组和观察组,每组63例,对照组使用二甲双胍+DDP-4抑制剂治疗,观察组使用二甲双胍+GLP-1受体激动剂治疗,比较2组的血糖[空腹血糖(FBG)、餐后2 h血糖(2hPG)]、体重、血压[收缩压(SBP)、舒张压(DBP)]和血脂[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白量固醇(HDL-C)、低密度脂蛋白量固醇(LDL-C)]变化,并记录不良反应发生率。结果观察组治疗后FBG、HbA1c、体重、腰围、BMI明显低于对照组(P<0.05),但2组2hPG差异无统计学意义(P>0.05);观察组治疗后SBP、TC、TG、LDL-C水平明显低于对照组,而HDL-C水平明显高于对照组(P<0.05),但2组治疗后DBP水平差异无统计学意义(P>0.05);2组低血糖发生率差异无统计学意义(P>0.05),但观察组恶心呕吐、腹胀腹泻、头晕、上呼吸道感染、鼻咽炎等不良反应发生率明显高于对照组(P<0.05)。结论GLP-1受体激动剂在治疗2型糖尿病患者中的整体效果更好,对FBG、HbAlc、体脂及体重的控制力更强,能有效降低SBP,增强对心血管保护作用,且低血糖发生率低,但有一定胃肠道不良反应及感染发生率,临床超重或肥胖2型糖尿病患者可优先选择GLP-1受体激动剂治疗。

Objective To explore the effectiveness of dipeptidyl peptidase-4(DPP-4)inhibitors and glucagon-like peptide-1(GLP-1)receptor agonists in the treatment of patients with type 2 diabetes mellitus(T2DM).Methods A total of 126 patients with T2 DM who were treated in the Endocrinology Department of our hospital from January 2019 to June 2020 were randomly divided into the control group(n=63)and the observation group(n=63).The control group was treated with metformin+DPP 4 inhibitor,and the observation group was treated with metformin+GLP-1 receptor agonist.The changes in blood glucose[fasting blood glucose(FBG),2h postprandial blood glucose(2hPG)],body mass index(BMI),blood pressure[systolic blood pressure(SBP),diastolic blood pressure(DBP)]and blood lipid[total cholesterol(TC),triacylglycerol(TG),high-density lipoprotein sterol(HDL-C),low-density lipoprotein sterol(LDL-C)]as well as the incidence rate of adverse reactions were compared between the two groups.Results After treatment,FBG,HbA1c,body weight,waist circumference and BMI of the observation group were significantly lower than those of the control group(P<0.05),but the difference in 2hPG was not statistically significant between the two groups(P>0.05).After treatment,SBP,TC,TG and LDL-C levels in the observation group were significantly lower than those of the control group,while the level of HDL-C was significantly higher than that of the control group(P<0.05),but there was no statistically significant difference in DBP levels between the two groups after treatment(P>0.05).There was no significant difference in the incidence of hypoglycemia between the two groups(P>0.05),but the incidence of adverse reactions such as nausea and vomiting,abdominal distension and diarrhea,dizziness,upper respiratory tract infection,and nasopharyngitis in the observation group was significantly higher than that in the control group(P<0.05).Conclusion GLP-1 receptor agonists have better overall effects in the treatment of patients with T2DM,and a stronger control of FBG,HbA1c,body fat and weight,which can effectively reduce SBP and enhance cardiovascular protection,with a low incidence of hypoglycemia.However,there is a certain incidence of gastrointestinal adverse reactions and infections.In clinical practice,overweight or obese patients with T2DM can preferentially choose GLP-1 receptor agonist therapy.