司美格鲁肽联合地特胰岛素治疗口服降糖药控制不佳肥胖2型糖尿病患者的效果

Effects of Semaglutide combined with Insulin detemir in treatment of patients with obese type 2 diabetes mellitus with poor control of oral hypoglycemic drugs

目的:观察司美格鲁肽联合地特胰岛素治疗口服降糖药控制不佳肥胖2型糖尿病(T2DM)患者的效果。方法:选取2022年6月至2023年9月该院收治的85例口服降糖药控制不佳肥胖T2DM患者进行前瞻性研究,按照随机数字表法将其分为研究组(n=43)与对照组(n=42)。对照组采用地特胰岛素治疗,研究组在对照组基础上联合司美格鲁肽治疗,比较两组临床疗效,治疗前后糖代谢指标[空腹血糖(FPG)、胰高血糖素样肽-1(GLP-1)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)]、脂代谢指标[三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)]、胰岛功能指标[空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)]水平,以及不良反应发生率。结果:研究组治疗总有效率为90.70%(39/43),高于对照组的71.43%(30/42),差异有统计学意义(P<0.05);治疗后,两组FPG、2hPG、HbAlc水平均低于治疗前,且研究组低于对照组,两组GLP-1水平均高于治疗前,且研究组高于对照组,差异有统计学意义(P<0.05);治疗后,两组TG、TC、LDL-C水平均低于治疗前,且研究组低于对照组,两组HDL-C水平均高于治疗前,且研究组高于对照组,差异有统计学意义(P<0.05);治疗后,两组FINS水平均高于治疗前,且研究组高于对照组,两组HOMA-IR均低于治疗前,且研究组低于对照组,差异有统计学意义(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:司美格鲁肽联合地特胰岛素治疗口服降糖药控制不佳肥胖T2DM患者可提高治疗总有效率,改善糖代谢指标、脂代谢指标和胰岛功能指标水平,效果优于单纯地特胰岛素治疗。

Objective:To observe effects of Semaglutide combined with Insulin detemir in treatment of obese type 2 diabetes mellitus(T2DM)patients with poor control of oral hypoglycemic drugs.Methods:A prospective study was conducted on 85 obese T2DM patients with poor control of oral hypoglycemic drugs admitted to the hospital from June 2022 to September 2023.According to the random number table method,they were divided into study group(n=43)and control group(n=42),The control group was treated with Insulin detemir,while the study group was treated with Semaglutide on the basis of that of the control group.The clinical efficacy,the levels of glucose metabolism indexes[fasting blood glucose(FPG),glucagon-like peptide-1(GLP-1),2 h postprandial blood glucose(2hPG),glycosylated hemoglobin(HbA1c)],lipid metabolism indexes[triglyceride(TG),total cholesterol(TC),low-density lipoprotein(LDL-C),high-density lipoprotein(HDL-C)]and islet function indexes[fasting insulin(FINS),insulin resistance index(HOMA-IR)]before and after the treatment,and the incidence of adverse reactions were compared between the two groups.Results:The total effective rate of treatment in the study group was 90.70%(39/43),which was higher than 71.43%(30/42)in the control group,and the difference was statistically significant(P<0.05).After the treatment,the levels of FPG,2hPG and HbAlc in the two groups were lower than those before the treatment,and those in the study group were lower than those in the control group;the levels of GLP-1 in the two groups were higher than those before the treatment,and that in the study group was higher than that in the control group;and the differences were statistically significant(P<0.05).After the treatment,the levels of TG,TC and LDL-C in the two groups were lower than those before the treatment,and those in the study group were lower than those in the control group;the HDL-C levels of the two groups were higher than those before the treatment,and that in the study group was higher than that in the control group;and the differences were statistically significant(P<0.05).After the treatment,the FINS levels of the two groups were higher than those before the treatment,and that in the study group was higher than that in the control group;the HOMA-IR of the two groups was lower than that before the treatment,and that in the study group was lower than that in the control group;and the differences were statistically significant(P<0.05).However,there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions:Semaglutide combined with Insulin detemir can improve the total effective rate and the levels of glucose metabolism indexes,lipid metabolism indexes and islet function indexes in the obese T2DM patients with poor control of oral hypoglycemic drugs.Moreover,it is superior to simple Insulin detemir treatment.