SGLT2抑制剂达格列净对2型糖尿病肾病患者血糖波动的影响

Effect of SGLT2 inhibitor dapagliflozin on blood glucose fluctuation in patients with type 2 diabetic nephropathy

目的探究SGLT2抑制剂达格列净对2型糖尿病肾病患者的血糖波动的影响。方法选取2020年8月至2022年3月(含随访时间)中国科学技术大学附属第一医院(安徽省立医院)内分泌科收治的101例血糖控制不佳,且既往未使用钠葡萄糖协同转运蛋白2(SGLT2)抑制剂的2型糖尿病肾病住院患者,不含达格列净治疗作为对照组(n=51),含达格列净治疗作为观察组(n=50),比较两组患者治疗前后血糖波动及尿白蛋白肌酐比(UACR)的差异。结果治疗1个月后,两组患者平均血糖(MBG)、血糖变异度(CV)、平均血糖标准差(SDBG)、平均血糖波动幅度(MAGE)、日间血糖平均绝对差(MODD)、高血糖(动态血糖值>10 mmol/L)和低血糖(动态血糖值<3.1 mmol/L)发生率均较治疗前下降,差异具有统计学意义(P<0.05),且观察组较对照组下降幅度大(P<0.05);两组患者治疗1、3、6个月后UACR也均较治疗前下降,差异具有统计学意义(P<0.05),观察组治疗后UACR较对照组下降幅度大(P<0.05)。结论SGLT2抑制剂达格列净在控制2型糖尿病肾病患者的血糖方面更为稳定,且较少出现低血糖等不良反应,同时还可以有效降低UACR。

Objective To investigate the effect of SGLT2 inhibitor dapagliflozin on blood glucose fluctuation in patients with type 2 diabetic nephropathy.Methods From August 2020 to March 2022(including follow-up period),101 inpatients with type 2 diabetic nephropathy who had poor blood glucose control without the use of sodium and glucose cotransporter 2(SGLT2)inhibitors were selected from the Department of Endocrinology,the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),and divided into two groups:treatment without dapagliflozin as the control group(n=51)and treatment with dapagliflozin as the observation group(n=50).The differences in blood glucose fluctuation and urinary albumin/creatinine ratio(UACR)between the two groups before and after treatment were compared.Results After one month of treatment,the incidence of average blood glucose(MBG),blood glucose variability(CV),average blood glucose standard deviation(SDBG),average blood glucose fluctuation range(MAGE),mean absolute difference of daytime blood glucose(MODD),hyperglycemia(dynamic blood glucose value>10 mmol/L)and hypoglycemia(dynamic blood glucose value<3.1 mmol/L)in both groups decreased compared with those before treatment,and the difference was statistically significant(P<0.05).In addition,1,3 and 6 months after treatment,the UACR of the two groups was also significantly lower than that before treatment,and the difference was statistically significant(P<0.05).The decrease of UACR in the observation group was larger than that in the control group after treatment(P<0.05).Conclusions SGLT2 inhibitor dapagliflozin is more stable in controlling blood glucos in patients with type 2 diabetic nephropathy,and has less adverse reactions such as hypoglycemia,and it can effectively reduce the ratio of urinary albumin to creatinine.