达格列净联合胰高血糖素样肽-1受体激动剂对2型糖尿病的疗效研究

Efficacy of dapagliflozin combined with glucagon-like peptide-1 receptor agonists for patients with type 2 diabetes mellitus

目的探讨达格列净联合胰高血糖素样肽-1受体激动剂(GLP-1 RAs)对2型糖尿病患者血液流变学及胰岛素抵抗的影响。方法将2020年11月—2022年10月泉州市中医院收治的102例2型糖尿病患者随机分为2组,每组51例。对照组给予达格列净治疗,研究组采用达格列净联合GLP-1 RAs(利拉鲁肽)的治疗方案。比较2组临床疗效、血糖指标[空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)]、空腹胰岛素(FINS)及胰岛素抵抗[胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-β)]、血脂指标[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、血液流变学指标[红细胞聚集指数(EAI)、红细胞压积(HCT)、红细胞变形指数(EDI)、血浆黏度(PV)]和不良反应。结果研究组总有效率为94.12%,高于对照组的80.39%,差异有统计学意义(P<0.05)。研究组和对照组治疗后FBG、2 hPG、HbAlc、BMI均低于治疗前,且研究组治疗后FBG、2 hPG、HbAlc水平低于对照组,差异有统计学意义(P<0.05)。治疗后,研究组FINS、HOMA-β水平高于对照组,HOMA-IR水平低于对照组,差异有统计学意义(P<0.05)。研究组和对照组治疗后HDL-C均高于治疗前,TC、TG、LDL-C水平均低于治疗前;研究组治疗后HDL-C水平高于对照组,TC、TG、LDL-C水平低于对照组,差异均有统计学意义(P<0.05)。治疗后,研究组和对照组EAI、HCT、EDI、PV水平均低于治疗前,且研究组EAI、HCT、EDI、PV水平低于对照组,差异均有统计学意义(P<0.05)。研究组不良反应总发生率为11.76%,与对照组的9.80%比较,差异无统计学意义(P>0.05)。结论达格列净联合GLP-1 RAs(利拉鲁肽)治疗2型糖尿病的疗效确切,可有效调节患者血糖及血脂水平,缓解胰岛素抵抗,改善血液流变学指标。

Objective To investigate the effects of dapagliflozin combined with glucagon-like peptide-1 receptor agonists(GLP-1 RAs)on hemorheology and insulin resistance in patients with type 2 diabetes mellitus.Methods A total of 102 patients with type 2 diabetes mellitus in Quanzhou City Hospital of Traditional Chinese Medicine from November 2020 to October 2022 were randomly divided into two groups,with 51 cases in each group.Control group was treated with dapagliflozin,while study group received a combination therapy of dapagliflozin and GLP-1 RAs(liraglutide).The clinical efficacy,blood glucose indicators[fasting blood glucose(FBG),2-hour postprandial glucose(2 hPG),glycated hemoglobin(HbA1c)],fasting insulin(FINS)and insulin resistance[homeostasis model assessment of insulin resistance(HOMA-IR),homeostasis model assessment ofβ-cell function(HOMA-β)],lipid indicators[total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-densitylipoprotein cholesterol(LDL-C)],hemorheological indicators[erythrocyte aggregation index(EAI),hematocrit(HCT),erythrocyte deformation index(EDI),plasma viscosity(PV)],and adverse reactions were compared between the two groups.Results The total effective rate was 94.12%in the study group,which was significantly higher than 80.39%in the control group(P<0.05).After treatment,FBG,2 hPG,HbA1c and BMI were significantly lower than those before treatment in both groups,and levels of FBG,2 hPG and HbA1c in the study group were significantly lower than those in the control group(P<0.05).After treatment,FINS and HOMA-βin the study group were significantly higher than those in the control group,while HOMA-IR was significantly lower than that in the control group(P<0.05).After treatment,HDL-C level was significantly higher than that before treatment in both groups,while TC,TG and LDL-C levels were significantly lower in both groups;additionally,HDL-C level after treatment in the study group was significantly higher than that in the control group,while TC,TG and LDL-C levels were significantly lower than those in the control group(P<0.05).After treatment,EAI,HCT,EDI and PV levels were significantly lower than those before treatment in both groups,and levels of indexes mentioned above in the study group were significantly lower than those in the control group(P<0.05).The total incidence of adverse reactions in the study group was 11.76%,which showed no significant difference when compared to 9.80%in the control group(P>0.05).Conclusion The combination therapy of dapagliflozin and GLP-1 RAs(liraglutide)is effective in the treatment of patients with type 2 diabetes mellitus,which can effectively regulate blood glucose and lipid levels,alleviate insulin resistance,and improve hemorheological indicators.