度拉糖肽联合二甲双胍治疗老年肥胖型糖尿病的疗效及对血清胰岛素样生长因子-1、Apelin-13水平的影响

The efficacy of dulaglutide combined with metformin in the treatment of elderly obese diabetes mellitus and its influence on serum insulin-like growth factor-1 and Apelin-13 levels

目的探讨度拉糖肽联合二甲双胍治疗老年肥胖型糖尿病的疗效及对血清胰岛素样生长因子-1(IGF-1)、Apelin-13水平的影响。方法前瞻性选取海安市人民医院2021年1月至2022年6月治疗的168例老年肥胖型糖尿病患者为研究对象,按随机数字表法分为对照组和观察组,每组84例,对照组在对症治疗基础上使用二甲双胍治疗,观察组在对照组基础上联合度拉糖肽治疗,两组均治疗24周。比较两组治疗效果、治疗前后体质量、体质量指数(BMI)、糖代谢指标、胰岛细胞功能指标及血清IGF-1、Apelin-13水平变化,并记录两组不良反应发生情况。结果观察组脱落5例(失访2例,未按规定服药3例),对照组脱落7例(失访3例,未按规定服药4例),最终观察组79例、对照组77例完成研究。治疗24周后观察组总有效率高于对照组[98.73%(78/79)比90.91%(70/77)],差异有统计学意义(χ^(2)=4.91,P<0.05)。治疗24周后,观察组体质量、BMI、空腹血糖、糖化血红蛋白、空腹胰岛素、胰岛素抵抗指数低于对照组[(76.85±3.96)kg比(77.96±2.16)kg、(27.98±2.01)kg/m2比(28.78±1.52)kg/m2、(5.86±0.63)mmol/L比(6.25±0.55)mmol/L、(6.44±0.35)%比(6.95±0.42)%、(9.26±0.54)mU/L比(9.97±0.63)mU/L、1.26±0.12比1.92±0.37];胰岛素分泌指数、IGF-1、Apelin-13水平高于对照组[79.20±5.71比73.50±6.14、(148.52±15.61)μg/L比(139.78±20.43)μg/L、(1865.52±101.34)ng/L比(1798.65±66.78)ng/L],差异均有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论度拉糖肽联合二甲双胍治疗老年肥胖型T2DM患者,减重、降糖作用明显,可保护胰岛β细胞功能,减轻胰岛素抵抗,维持血糖稳态,并且提升IGF-1、Apelin-13水平,且安全性高。

Objective To explore the efficacy of dulaglutide combined with metformin in the treatment of elderly obese diabetes mellitus and its influence on serum insulin-like growth factor-1(IGF-1)and Apelin-13 levels.Methods A total of 168 elderly obese diabetic patients admitted to the Hai′an People′Hospital from January 2021 to June 2022 were prospectively selected and divided into the control group(84 cases)and the observation group(84 cases)by simple random methods.The control group was given metformin on the basis of symptomatic treatment,and the observation group was given dulaglutide on the basis of the control group.The course of treatment was 24 weeks.The effects of treatment and the changes of body weight,body mass index(BMI),glucose metabolism,islet cell function,and serum IGF-1,Apelin-13 levels before and after treatment were recorded between the two groups.Results A total of 5 cases fell off in the observation group(2 cases lost to follow-up,3 cases did not take medicine as prescribed),and 7 cases fell off in the control group(3 cases lost to follow-up,4 cases did not take medicine as prescribed).Finally,79 cases in the observation group and 77 cases in the control group completed the study.At the end of treatment for 24 weeks,the total effective rate in the observation group was higher than that in the control group:98.73%(78/79)vs.90.91%(70/77),there was statistical difference(χ^(2)=4.91,P<0.05).At the end of treatment for 24 weeks,the body weight and BMI in the two groups were lower than those before treatment(P<0.05).Body weight,BMI,fasting blood glucose(FPG),glycated hemoglobin(HbA1c),fasting insulin(FINS)and insulin resistance index(HOMA-IR)in the observation group were lower than those in the control group:(76.85±3.96)kg vs.(77.96±2.16)kg,(27.98±2.01)kg/m2 vs.(28.78±1.52)kg/m2,(5.86±0.63)mmol/L vs.(6.25±0.55)mmol/L,(6.44±0.35)%vs.(6.95±0.42)%,(9.26±0.54)mU/L vs.(9.97±0.63)mU/L,1.26±0.12 vs.1.92±0.37;the levels of insulin secretion index(HOMA-β),IGF-1 and Apelin-13 were higher than those in the control group:79.20±5.71 vs.73.50±6.14,(148.52±15.61)μg/L vs.(139.78±20.43)μg/L,(1865.52±101.34)ng/L vs.(1798.65±66.78)ng/L,there were statistical differences(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions Dulaglutide combined with metformin has obvious effects on weight loss and hypoglycemia in elderly obese T2DM patients,which can protect pancreaticβcell function,reduce insulin resistance,maintain blood glucose homeostasis,improve IGF-1 and Apelin-13 levels and with high safety.