基础胰岛素联合GLP-1受体激动剂方案治疗超重肥胖T2DM的效果

Clinical Effect of Multiple Insulin Combined with GLP-1 Receptor Agonist in the Treatment of Overweight and Obese T2DM

目的:观察多次胰岛素注射转换为基础胰岛素联合胰高血糖素样肽-1(GLP-1)受体激动剂方案治疗超重肥胖2型糖尿病(T2DM)的效果及对生活质量的影响。方法:选择2019年8月-2021年8月在江门市五邑中医院就诊的80例超重肥胖T2DM患者为研究对象。按随机数字表法分为观察组(n=40)和对照组(n=40)。所有患者研究前均采用多次胰岛素注射方案,且嘱患者糖尿病饮食并加强运动锻炼。对照组无转换用药,继续多次胰岛素注射方案,观察组转换用药,多次胰岛素转换为基础胰岛素联合胰高血糖素样肽-1(GLP-1)受体激动剂方案,比较治疗前及治疗3个月后两组BMI和血糖相关指标[糖化血红蛋白(HbA1c)、空腹血糖(FBG)、餐后2 h血糖(2 h PG)]变化,比较两组胰岛功能[空腹胰岛素(FINS)、胰岛β细胞功能(HOMA-β)和胰岛素抵抗指数(HOMA-IR)]和生活质量[糖尿病生存质量特异性量表(DSQL)]差异,比较治疗3个月内两组不良反应发生情况差异。结果:治疗3个月后,两组FBG、2 h PG、HbA1c和HOMA-IR较治疗前均降低,FINS和HOMA-β较治疗前均升高,观察组BMI和DSQL评分较治疗前均降低(P<0.05),观察组BMI、HbA1c、FINS、HOMA-β、HOMA-IR水平和DSQL评分改善程度均优于对照组(P<0.05)。治疗3个月内,观察组低血糖发生率、不良反应发生率较对照组均更低(P<0.05)。结论:多次胰岛素注射转换为基础胰岛素联合GLP-1受体激动剂方案治疗超重肥胖T2DM患者可有效控制血糖,改善胰岛功能,降低BMI水平,可在提高患者生活质量的同时减少低血糖不良反应发生风险。

Objective:To observe the effect of multiple Insulin injection combined with basal Insulin and glucagon like peptide-1(GLP-1)receptor agonist regimen in the treatment of overweight and obese type 2 diabetes mellitus(T2DM)and its influence on quality of life.Method:A total of 80 overweight and obese T2DM patients treated in Wuyi Hospital of Traditional Chinese Medicine of Jiangmen City from August 2019 to August 2021 were selected as the research objects.They were divided into observation group(n=40)and control group(n=40)according to the random number table method.Prior to the study,all patients received multiple Insulin injections,and ordered diabetic patients to diet and exercise.The control group did not change medication,continued multiple Insulin injection regimen,the observation group switched from multiple Insulin to basal Insulin combined with glucagon like peptide-1(GLP-1)receptor agonist.The changes of BMI,blood glucose related indexes[glycosylated hemoglobin(HbA1c),fasting blood glucose(PBG)and 2 h postprandial blood glucose(2 h PG)],islet function[fasting Insulin(FINS)and isletβCellular function(HOMA-β)and Insulin resistance index(HOMA-IR)]and quality of life[diabetes quality of life scale(DSQL)]of two groups before treatment and 3 months after treatment were compared.The difference of adverse reactions between two groups within 3 months of treatment was compared.Result:After 3 months of treatment,the levels of FBG,2 h PG,HbA1c and HOMA-IR in two groups decreased significantly compared with those before treatment,and FINS and HOMA-βin two groups increased compared with those before treatment,the BMI level and DSQL scores of the observation group were significantly lower than those before treatment(P<0.05),and the improvement degree of BMI,HbA1c,FINS,HOMA-β,HOMA-IR and DSQL scores in the observation group were significantly better than those in the control group(P<0.05).Within 3 months of treatment,the incidence of hypoglycemia and adverse reactions in the observation group were significantly lower than those in the control group(P<0.05).Conclusion:Multiple Insulin injections converted to basic Insulin combined with GLP-1 receptor agonist regimen in the treatment of overweight and obese T2DM patients can effectively control blood glucose,improve islet function,reduce BMI level,improve patients’quality of life and significantly reduce the risk of hypoglycemic adverse reactions.