利拉鲁肽与达格列净分别联合二甲双胍对肥胖2型糖尿病患者糖脂代谢的影响比较

Effects of liraglutide and dapagliflozin combined with metformin on glucose and lipid metabolism in obese patients with type 2 diabetes mellitus

目的比较利拉鲁肽与达格列净分别联合二甲双胍对肥胖2型糖尿病(T2DM)患者糖脂代谢的影响。方法以随机数字表法将2022年2月—2023年11月福建中医药大学附属晋江中医院收治的肥胖T2DM患者81例分为A、B、C组,各27例。A组单用二甲双胍治疗,B组使用达格列净联合二甲双胍治疗,C组使用利拉鲁肽联合二甲双胍治疗,3组均治疗3个月。比较3组体质指数(BMI)、腰围(WC)、血脂指标[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、血糖指标[空腹血糖(FBG)、餐后2 h血糖(2 hPBG)、糖化血红蛋白(HbA_(1c))]、胰岛功能指标[空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)]及不良反应。结果治疗3个月后,B组BMI、WC及C组BMI均低于A组,且C组BMI低于B组(P<0.05或P<0.01),C组WC与A组、B组组间比较差异均不显著(P>0.05);B组、C组TC、TG、LDL-C、FBG、2 hPBG、HbA_(1c)、FINS水平及HOMA-IR均低于A组,HDL-C水平与HOMA-β均高于A组(P<0.05或P<0.01),但B组与C组上述指标比较差异不显著(P>0.05)。3组不良反应总发生率比较差异不显著(11.11%vs.22.22%vs.18.52%,χ^(2)=0.956,P=0.620)。结论利拉鲁肽联合二甲双胍与达格列净联合二甲双胍均较单用二甲双胍的疗效更佳,可有效调节肥胖T2DM患者的糖脂代谢水平,改善胰岛功能,其中利拉鲁肽联合二甲双胍对患者减重效果更佳,且2组联合用药的安全性均较高。

Objective To compare the effects of liraglutide and dapagliflozin combined with metformin on glucose and lipid metabolism in obese patients with type 2 diabetes mellitus(T2DM).Methods According to the random number table method,81 obese patients with T2DM admitted to Jinjiang Traditional Chinese Medicine Hospital Affiliated to Fujian University of Traditional Chinese Medicine from February 2022 to November 2023 were divided into A group,B group and C group,27 cases in each group.A group was treated with metformin alone,B group was treated with dapagliflozin combined with metformin,and C group was treated with liraglutide combined with metformin.All three groups were treated for 3 months.The BMI,WC,blood lipid indexes(TC,TG,HDL-C,LDL-C),blood glucose indexes(FBG,2 hPBG,HbA 1c),islet function indexes(FINS,HOMA-IR,HOMA-β)and adverse reactions were compared among the three groups.Results After 3 months of treatment,BMI,WC in B group and BMI in C group were lower than those in A group,and BMI in C group was lower than that in B group(P<0.05 or P<0.01).There was no significant difference in WC between C group and A、B groups(P>0.05).The levels of TC,TG,LDL-C,FBG,2 hPBG,HbA 1c,FINS and HOMA-IR in B group and C group were lower than those in A group,while the levels of HDL-C and HOMA-βwere higher than those in A group(P<0.05 or P<0.01),but there was no significant difference between B group and C group(P>0.05).There was no significant difference in the total incidence of adverse reactions among the three groups(11.11%vs.22.22%vs.18.52%,χ^(2)=0.956,P=0.620).Conclusion Liraglutide combined with metformin and dapagliflozin combined with metformin have better efficacy than metformin alone,which can effectively regulate the glucose and lipid metabolism level of obese T2DM patients and improve islet function.Liraglutide combined with metformin has better weight loss effect for patients,and the safety of the combination of the two groups is higher.