度拉糖肽联合德谷胰岛素对2型糖尿病患者葡萄糖在目标范围内时间的影响

Effects of dulaglutide combined with insulin degludec on time in range in type 2 diabetes mellitus

目的 探讨度拉糖肽联合德谷胰岛素对T2DM患者葡萄糖在目标范围内时间(TIR)的影响。方法 选取2020年7月至2021年12月于苏州大学附属第三医院内分泌科治疗的T2DM患者116例,随机分为度拉糖肽+德谷胰岛素+口服降糖药(OADs)组56例及德谷胰岛素+OADs组60例,治疗6月后观察各组血糖波动和TIR变化。结果 度拉糖肽+德谷胰岛素+OADs组血糖水平标准差、平均血糖波动幅度、最大血糖波动幅度、餐后血糖波动幅度低于德谷胰岛素+OADs组(P<0.05)。度拉糖肽+德谷胰岛素+OADs、德谷胰岛素+OADs组TIR≥70%比例随着治疗时间延长,达标趋势明显。治疗6个月时度拉糖肽+德谷胰岛素+OADs组仍有89.2%使用度拉糖肽。结论 度拉糖肽联合德谷胰岛素可减少T2DM患者整体血糖波动,升高TIR达标率,长期应用GLP-1受体激动剂可减少甚至停用胰岛素。

Objective To evaluate the effect of dulaglutide combined with insulin degludec on glucose within time in range(TIR)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 116 T2DM patients who were treated in the Department of Endocrinology of The Third Affiliated Hospital of Suzhou University were enrolled in this study from July 2020 to December 2021. All the subjects were randomly divided into Dulaglutide+degludec+OADs group(n=56)and Degludec+OADs group(n=60).They were followed up for 6 months. Blood fluctuation and TIR were evaluated.Results Standard deviation of blood glucose,mean amplitude of glycaemic excursion,largest amplitude of glycaemic excursion and postprandial glucose excursion were lower in Dulaglutide+degludec+OADs group than in Degludec+OADs group(P< 0. 05). The proportions of TIR≥70% were 44% and 10% on the second day,89% and 48%on the fourth day,96% and 48% on the seventh day,and 100% and 67% on the tenth day,respectively in the Dulaglutide+degludec+OADs group and Degludec+OADs group. With the extension of treatment time,the achievement trend became more obvious. At 6 months of follow up,89. 2% of patients were still treated with Dulaglutide in Dulaglutide+degludec+OADs group.Conclusion Dulaglutide combined with insulin degludec can significantly reduce the overall blood glucose fluctuation in patients with T2DM and improve the TIR achievement,long-term use of GLP-1 receptor agonist can reduce or even stop insulin treatment.