达格列净对2型糖尿病合并慢性心力衰竭患者微小RNA-423-5p的调控作用及心功能的影响研究

背景 糖尿病合并心力衰竭的患者数量庞大,达格列净作为新型降糖药物,目前已被指南推荐用于心力衰竭的治疗,但其改善心功能的作用机制还未完全明确。目的 研究达格列净对2型糖尿病（T2DM）合并慢性心力衰竭（CHF）患者血浆微小RNA-423-5p(miRNA-423-5p)表达的影响及其与心功能之间的相关性。方法 纳入2021-04-01至2021-11-30就诊于解放军第九六〇医院的T2DM合并CHF患者50例为研究对象,分为达格列净组（n=25）和对照组（n=25）,达格列净组给予达格列净10 mg/d,对照组给予其他降糖药物,余治疗原则相同,治疗6个月。另纳入同一时期于本院健康体检的心功能正常者为健康人群组（n=25）。通过数字病历系统收集患者的基本资料,包括年龄、性别、吸烟史、高血压史、血压水平、体质指数（BMI）、血脂、血糖、肌酐（Cr）、氨基末端脑钠肽前体（NT-proBNP）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、纽约心脏病协会（NYHA）心功能分级、心脏彩超、合并用药情况,并留取血液标本进行miRNA-423-5p的检测。治疗4周进行门诊随访,收集患者心功...     

Commentary: SGLT inhibitors in type 1 diabetes: Place in therapy and a risk mitigation strategy for preventing diabetic ketoacidosis - the STOP DKA protocol

In the accompanying article, Goldenberg et al. review the promotion of diabetic ketoacidosis by SGLT2 inihibitors. They have carried out a metanalysis showing a 3.5-fold increase in the risk of diabetic ketoacidosis (DKA) in patients with type 1 diabetes under treatment with SGLT2 inhibitors. They make a number of suggestions for attempting to mitigate the risk of DKA in these patients, notably including blood ketone monitoring and the use of supplemental carbohydrates with additional insulin when ketones suggest incipient DKA. Their proposal merits evaluation in a clinical trial involving type 1 diabetes, which should also assess the possible cardiorenal benefits demonstrated with treatment with SGLT2 inhibitors in type 2 diabetes.     

Sodium glucose co-transporter inhibitors for the management of diabetes mellitus: an opinion paper from the Endocrine and Metabolism Practice and Research Network of the American College of Clinical Pharmacy

Type 2 diabetes mellitus (T2DM) carries a high prevalence in the United States and worldwide. Therefore, the number of medication classes being developed and studied has grown. The individualized management of diabetes is accomplished by evaluating a medication’s efficacy, safety, and cost, along with the patient’s preference and tolerance to the medication. Sodium glucose co-transporter 2 inhibitors are a new therapeutic class indicated for the treatment of diabetes and have a unique mechanism of action, independent of beta-cell function. The first agent approved by the Food and Drug Administration (FDA) was canagliflozin in March 2013. Two agents – dapagliflozin and empagliflozin – were FDA-approved in January and July 2014, respectively. A clear understanding of the new class is needed to identify its appropriate use in clinical practice. Members of the American College of Clinical Pharmacy Endocrine and Metabolism Practice and Research Network reviewed available literature regarding this therapeutic class. The article addresses the advantages, disadvantages, emerging role, and patient education for sodium glucose co-transporter 2 inhibitors. Key limitations for this article include limited access to clinical trial data not published by the pharmaceutical company and limited data on products produced outside the United States.     

达格列净联合利拉鲁肽治疗2型糖尿病的临床研究

目的 探究达格列净联合利拉鲁肽治疗2型糖尿病患者的临床效果。方法 收集2017年1月—2019年4月在郑州人民医院治疗的2型糖尿病患者126例,随机分为对照组（63例）和治疗组（63例）。对照组口服盐酸二甲双胍片,0.5 g/次,3次/d,同时于睡前皮下注射利拉鲁肽注射液0.6 mg,1周后根据患者肠道反应增加至1.2 mg,1次/d。治疗组早餐前口服达格列净片,10 mg/次,1次/d;利拉鲁肽注射液的用法同对照组。两组患者治疗时间均为3个月。观察两组患者临床疗效,同时比较治疗前后两组患者糖化血红蛋白（HbA1c）、空腹血糖（FPG）、餐后2 h血糖（2 h PG）、体质量指数（BMI）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、对纤溶酶原激活物抑制物-1（PAI-1）和胱抑素C（CysC）水平。结果 治疗后,对照组和治疗组临床有效率分别为79.37%和93.65%,两组比较差异有统计学意义（P<0.05）。治疗后,两组患者HbA1c、FPG、2 h PG、BMI、IL-6、TNF-α、PAI-1、CysC均显著降低（P<0.05）,且治疗组上述指标比对照组更低（P<0.05）。结论 达格列净联合利拉鲁肽治疗2型糖尿病患者效果显著,且不增加不良反应,降低发生糖尿病血管并发症的风险。     

津力达颗粒联合达格列净治疗老年2型糖尿病的临床研究

目的探讨津力达颗粒联合达格列净片治疗老年2型糖尿病的临床效果。方法选取2017年9月—2019年5月内蒙古自治区人民医院收治的84例2型糖尿病老年患者,随机分成对照组(42)和治疗组(42例)。对照组晨服达格列净片,10mg/次,1次/d。治疗组在对照组基础上口服津力达颗粒,1袋/次,3次/d。两组均连续治疗12周。观察两组患者临床疗效,同时比较治疗前后两组患者体质量指数(BMI)值、外周血中性粒细胞与淋巴细胞比值(NLR)、胰岛素抵抗(HOMA-IR)值、胰岛β细胞功能(HOMA-β)值及血清糖化血红蛋白(HbA1c)、空腹血糖(FPG)、餐后2 h血糖(2 h PG)、C反应蛋白(CRP)、淀粉样蛋白A(AA)、丙二醛(MDA)、超氧化物歧化酶(SOD)水平。结果治疗后,对照组和治疗组总有效率分别为81.0%、95.2%,两组比较差异有统计学意义(P0.05)。治疗后,两组患者血清HbA1c、FPG和2 h PG水平及BMI值均显著低于治疗前(P0.05),且治疗组下降程度比对照组更显著(P0.05)。治疗后,两组患者外周血NLR值和血清CRP、AA水平均显著降低(P0.05),且治疗组上述微炎症标志物均显著低于对照组(P0.05)。治疗后,两组患者HOMA-IR值及血清MDA水平较治疗前均显著降低(P0.05),而HOMA-β值和血清SOD水平均显著增加(P0.05),且治疗组以上指标的改善效果更明显(P0.05)。结论津力达颗粒联合达格列净片治疗老年2型糖尿病的整体疗效确切,有助于控制血糖,改善机体微炎症状态,纠正体内氧化应激,保护胰岛功能。     

达格列净联合比格列酮治疗2型糖尿病的临床研究

目的探讨达格列净片联合吡格列酮片治疗2型糖尿病的临床疗效。方法选取2018年1月—2019年1月深圳市第二人民医院收治的86例2型糖尿病患者纳入本研究,根据用药方案之间的差异将患者分为对照组和治疗组,每组各43例。对照组于早饭前口服吡格列酮片,2片/次,1次/d。治疗组在对照组的基础上于早晨口服给予达格列净片,0.5片/次,1次/d。两组患者均治疗3个月。观察两组患者临床疗效,同时比较治疗前后两组患者血糖指标、氧化应激指标水平。结果治疗后,对照组、治疗组总有效率分别为72.1%、90.7%,两组总有效率比较差异具有统计学意义(P0.05)。治疗后,两组空腹血糖(FBG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)水平均显著降低,胰高血糖素样肽1(GLP-1)水平显著升高,同组治疗前后比较差异具有统计学意义(P0.05);且治疗后治疗组血糖指标均明显优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组谷胱甘肽过氧化物酶(GSH-PX)、超氧化物歧化酶(SOD)、总抗氧化能力(T-Aoc)水平均显著升高,丙二醛(MDA)水平显著降低,同组治疗前后比较差异具有统计学意义(P0.05);且治疗后治疗组氧化应激指标均明显优于对照组,两组比较差异具有统计学意义(P0.05)。结论达格列净片联合吡格列酮片治疗2型糖尿病具有较好的临床疗效,可改善患者血糖水平,缓解氧化应激状态,具有一定的临床推广应用价值。     

Efficacy of dapagliflozin as an adjunct therapy in patients with inadequately controlled type 1 diabetes mellitus

Introduction: There is a clear unmet clinical need in people with Type 1 diabetes (T1DM) considering present day insulin therapy. New insulin analogues and novel technologies allowing more tailored insulin administration have improved the quality of life of people with T1DM, but issues like hypoglycemia, weight gain and variability in glucose profiles remain problematic.

Areas covered: In this review, the clinical efficacy, safety and tolerability of dapagliflozin, a sodium-glucose cotransporter type 2 inhibitor, in type 1 diabetes (T1DM) is described based on a review of phase 2 and 3 studies to date.

Expert opinion: Dapagliflozin has shown promising results as an adjunct therapy in T1DM, resulting in better glucose control, weight loss and lower blood pressure. No increase in hypoglycemia risk, in particular severe hypoglycemia, was observed, but, in comparison with reports in Type 2 diabetes (T2DM), genital infections were more prevalent. Dapagliflozin use was accompanied with decreases in insulin doses, but, to date, only a low risk of diabetic ketoacidosis (DKA) was reported. However, caution is needed when interpreting this data, arising from well controlled clinical trials, with intensive education programs around ketone measurements and DKA prevention. Further studies will need to establish how high the DKA risk is and how to mitigate this in a real-world setting.     

A series of diabetic ketoacidosis associated with the use of sodium-glucose co-transporter-2 inhibitors in secondary care

Background and aimsSodium-glucose co-transporter-2 inhibitors (SGLT-2i) are associated with diabetic ketoacidosis (DKA), however limited case series are published.MethodsWe evaluated the characteristics of patients admitted with SGLT-2i associated DKA.ResultsOver 4 months, 22 patients were identified; 45.5% of DKA was not associated with concurrent illness.ConclusionDKA is not uncommonly associated with SGLT2i with no clear patient factors associated with severity.     

达格列净联合短期胰岛素强化治疗对初治2型糖尿病患者代谢指标的影响

目的探讨新诊断2型糖尿病（T2DM）患者在短期胰岛素强化治疗的基础上联用达格列净对代谢指标的影响。 方法入选2018年5月至2020年8月于东莞东华医院内分泌科住院的新诊断T2DM患者60例,随机分为试验组（短期胰岛素强化+达格列净）和对照组（短期胰岛素强化）,收集治疗前（d0）、血糖达标后14天（D14）及停药后随访第12周（W12）的资料,分析两组患者的代谢指标的变化。 结果两组患者的体重、体质量指数（BMI）及腰围在W12时仍出现明显下降,且试验组下降更显著;试验组的血尿酸（UA）在D14出现明显下降,但停药后明显回升,而对照组的UA治疗前后无明显变化;两组患者的甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）在治疗后均出现明显下降,试验组高密度脂蛋白胆固醇（HDL-C）在停药后明显升高,而对照组治疗前后无明显变化。 结论对于新诊断的T2DM患者,在早期胰岛素强化降糖的同时加用达格列净治疗,可更显著减少体重、BMI、腰围,改善患者HDL-C等代谢指标。     

达格列净联合二甲双胍治疗2型糖尿病的临床效果分析

目的观察不同药物方案治疗2型糖尿病(T2DM)的效果。方法选择2019年8月—2020年7月收治的128例T2DM患者,分为I、II组,均用二甲双胍治疗,II组联合达格列净,比较两组治疗情况。结果治疗后,II组FPG、2 hPG、HbAlc、HOMA-IR、FIns分别为(7.10±1.45)mmol/L、(8.12±1.95)mmol/L、(6.67±1.07)%、(3.01±1.09)、(14.31±3.55)mmol/L,和同期I组(9.12±1.54)mmol/L、(9.84±2.01)mmol/L、(8.03±1.42)%、(4.57±0.04)、(11.42±3.43)mmol/L,差异有统计学意义(t=3.284、4.257、3.257、3.875、4.527,P=0.040、0.037、0.041、0.039、0.035<0.05);I、II组不良反应发生率分别为12.50%、10.94%,差异无统计学意义(χ²=0.076,P=0.783>0.05)。结论采用达格列净与二甲双胍联合方案治疗T2DM,能更好的控制血糖水平,疗效确切,且安全性较高。