二甲双胍联合达格列净对超重2型糖尿病患者早期糖尿病肾病及胰岛功能的影响

Effect of metformin combined with dapagliflozin on early diabetic nephropathy and islet function in overweight patients with type 2 diabetes mellitus

目的分析二甲双胍联合达格列净对超重2型糖尿病(T2DM)患者早期糖尿病肾病(DKD)及胰岛功能的影响。方法选取2020年7月至2022年1月就诊该院的69例超重T2DM患者进行研究,随机分为研究组(二甲双胍联合达格列净)和对照组(单用二甲双胍),治疗周期24周,比较两组治疗前后尿微量白蛋白/肌酐比(UACR)及胰岛功能的变化。结果治疗前,两组体质量、BMI、HbA1c、FPG、FINS、FCP、SCr、SUA、TC、TG、LDL-C、HDL-C、UACR、SBP、DBP指标相比,差异无统计学意义(P>0.05)。治疗24周后,研究组患者体质量、BMI、HbA1c、FPG、UACR、胰岛素抵抗指数较治疗前明显降低,差异有统计学意义(P<0.05),研究组空腹胰岛素(FINS)、稳态胰岛β细胞分泌功能指数高于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率相当,差异无统计学意义(P>0.05)。结论二甲双胍联合达格列净治疗超重T2DM患者,可明显降低血糖,减少UACR、改善胰岛β细胞功能,联合用药效果好,不良反应发生率低,对早期DKD有改善作用,值得临床推广使用。

Objective To analyze the effect of metformin combined with dapagliflozin on early diabetic nephropathy and islet function in overweight patients with type 2 diabetes mellitus(T2DM).Methods 69 overweight T2DM patients in the hospital from July 2020 to January 2022 were selected and randomly divided into the study group(metformin combined with dapagliflozin)and the control group(metformin alone).The treatment period was 24 weeks.The changes of urinary albumin/creatinine ratio(UACR)and islet function after treatment were compared between the two groups.Results Before treatment,there were no significant differences in body weight,BMI,HbA1c,FPG,FINS,FCP,SCr,SUA,TC,TG,LDL-C,HDL-C,UACR,SBP and DBP between the two groups(P>0.05).After 24 weeks of treatment,the body weight,BMI,HbA1c,FPG,UACR and HOMA-IR in the study group were significantly lower than those before treatment,and the differences were statistically significant(P<0.05),fasting insulin(FINS)and homeostasis isletβ-cell secretory function index(HOMA-β)in the study group were higher than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse events between the two group(P<0.05).Conclusion Metformin combined with dapagliflozin in the treatment of overweight patients with T2DM can significantly reduce blood glucose and UACR effectively,meanwhile improve isletβ-cell function.The combination effect is good,with a low incidence of adverse events,which can also improve early diabetic nephropathy,worthy widely applying in clinic.