达格列净联合胰岛素和二甲双胍对2型糖尿病患者血糖波动影响的临床观察

Clinical observation of dapagliflozin combined with insulin and metformin on blood glucose fluctuation in patients with type 2 diabetes mellitus

目的研究达格列净联合胰岛素和二甲双胍对2型糖尿病(T2DM)患者血糖波动的影响。方法选取2021年1月至2022年6月于山东中医药大学第二附属医院内分泌科就诊的应用胰岛素联合二甲双胍治疗的T2DM患者70例,采用随机数字表法分为达格列净组和对照组,各35例。对照组维持糖尿病治疗原方案;达格列净组在糖尿病治疗原方案基础上给予达格列净口服,2组均持续治疗12周。比较2组治疗前后一般资料、生化指标、血糖指标。记录治疗期间患者低血糖发生情况。结果治疗后,达格列净组体质量、体重指数、收缩压及舒张压均低于治疗前,收缩压、舒张压及胰岛素用量均低于对照组,差异均有统计学意义(均P<0.05);达格列净组血尿酸、三酰甘油、总胆固醇、低密度脂蛋白胆固醇(LDL-C)及尿微量白蛋白水平均低于治疗前,且血尿酸、三酰甘油、总胆固醇及LDL-C水平均低于对照组,差异均有统计学意义(均P<0.05)。治疗后,2组空腹血糖、糖化血红蛋白、平均葡萄糖均低于治疗前,且达格列净组均低于对照组[(6.2±0.9)mmol/L比(6.7±0.8)mmol/L、(7.1±0.6)%比(7.4±0.5)%、(8.6±0.8)mmol/L比(9.2±0.7)mmol/L](均P<0.05);2组葡萄糖目标范围内时间(TIR)及对照组葡萄糖低于目标范围时间(TBR)均高于治疗前,且达格列净组TIR高于对照组[(68±13)%比(62±10)%]、TBR低于对照组[(4.3±2.8)%比(9.5±3.2)%](均P<0.05)。治疗期间,达格列净组3例患者发生低血糖,对照组6例患者发生低血糖,其中2例患者发生2次。结论达格列净联合胰岛素和二甲双胍可明显改善T2DM患者糖代谢,减少血糖波动及低血糖事件发生。

Objective To investigate the effect of dapagliflozin combined with insulin and metformin on blood glucose fluctuation in patients with type 2 diabetes mellitus(T2DM).Methods From January 2021 to June 2022,70 patients with T2DM who were treated with insulin combined with metformin from Department of Endocrinology,the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine were enrolled.They were divided into dapagliflozin group and control group by the random number table method,with 35 cases in each group.The control group was treated with original plan for diabetes mellitus,and the dapagliflozin group was treated with oral dapagliflozin based on original plan for diabetes mellitus,all with continuous treatment for 12 weeks.The general data,biochemical indexes and blood glucose indexes were compared between the two groups before and after treatment.ResultsAfter treatment,levels of body mass,body mass index,and systolic and diastolic blood pressure in the dapagliflozin group were lower than those before treatment,and systolic and diastolic blood pressure and dosage of insulin in the dapagliflozin group were lower than those in the control group(all P<0.05);levels of serum uric acid,triacylglycerol,total cholesterol,low-density lipoprotein cholesterol(LDL-C)and urinary microalbumin in the dapagliflozin group were lower than those before treatment,and levels of serum uric acid,triacylglycerol,total cholesterol and LDL-C in the dapagliflozin group were lower than those in the control group(all P<0.05).After treatment,levels of fasting plasma glucose,glycosylated hemoglobin and mean glucose in the two groups were lower than those before treatment,and the above levels in the dapagliflozin group were lower than those in the control group[(6.2±0.9)mmol/L vs(6.7±0.8)mmol/L,(7.1±0.6)%vs(7.4±0.5)%,(8.6±0.8)mmol/L vs(9.2±0.7)mmol/L](all P<0.05).The time in range(TIR)in both groups and the time below the target range(TBR)in the control group were higher than those before treatment,TIR was higher[(68±13)%vs(62±10)%]and TBR was lower[(4.3±2.8)%vs(9.5±3.2)%]in the dapagliflozin group(all P<0.05).During treatment,there were 3 cases with hypoglycemic events in the dapagliflozin group and 6 cases in the control group,including 2 episodes in 2 cases.Conclusion Dapagliflozin combined with insulin and metformin can significantly improve glucose metabolism in patients with T2DM and reduces the occurrence of blood glucose fluctuation and hypoglycemia events.