洛塞那肽联合达格列净序贯治疗早期超重或肥胖2型糖尿病患者的临床观察

目的探讨超重或肥胖早期2型糖尿病(T2DM)患者的优选序贯治疗方案。方法选取2018年10月至2020年10月在广东省中西医结合医院门诊或住院的90例早期超重或肥胖T2DM患者,采用随机数字表法分为对照组、达格列净组和序贯治疗组,每组30例。对照组予以二甲双胍0.5 g/片,2片/次,口服,2次/d;达格列净组予以达格列净10 mg,口服,1次/d;序贯治疗组予以聚乙二醇洛塞那肽0.2 mg,皮下注射1周1次,连续使用6个月后停用,改达格列净10 mg,口服,1次/d。总疗程为1年,1年后观察3组体质量、体质量指数(BMI)、腰围、空腹血糖(FPG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、瘦素、脂联素、胰岛素抵抗指数(HOMA-IR)等指标水平变化情况。结果与治疗前相比,各组治疗后体质量、BMI、腰围、FPG、FINS、HOMA-IR、Hb A1c、瘦素均较治疗前下降(P<0.05)。3组治疗前后体质量、BMI、腰围差值比较,差异有统计学意义(P<0.05)。3组治疗前后FPG、FINS、HOMA-IR差值比较,差异有统计学意义(P<0.05)。3组治疗前后HbA1c、瘦素、脂联素差值比较,差异有统计学意义(P<0.05)。结论聚乙二醇洛塞那肽联合达格列净序贯治疗早期超重或肥胖T2DMZ患者在降低血糖的同时,还能明显减重及改善胰岛素抵抗,其可作为早期超重或肥胖T2DM患者的优选治疗方案。

Treatment of polyethylene glycol-loxenatide sequential combined with dapagliflozin for early obesity or overweight T2DM

【Objective】To explore the preferred treatment for overweight and obese patients with type 2 diabetes mellitus(T2DM)in the early stage.【Methods】A total of 90 overweight or obese T2DM patients who were treated in our hospital were selected,and the patients were randomly divided into the control group,the Dapagliflozin group and the Dapagliflozin+Loxenatide group.The control group was treated with metformin,the Dapagliflozin group was treated with dapagliflozin,while the Dapagliflozin+Loxenatide group was treated with polyethylene glycol loxenatide for six mouths and then treated with dapagliflozin for half a year.All patients were treated continuously for 1 year.Weight,body mass index(BMI),waist circumference,glycated hemoglobin(Hb Alc),fasting plasma glucose(FPG),fasting insulin(FINS),homeostasis model assessment of insulin resistance(HOMA-IR),adiponectin and leptin were recorded before and after treatment.【Results】Compared with before treatment,weight,BMI,waist circumference,HbA1c,FPG,FINS,HOMA-IR and leptin in each group decreased after treatment(P<0.05).The difference of body mass,BMI and waist circumference before and after treatment was significantly different among three groups(P<0.05).The difference of FPG,FINS,HOMA-IR before and after treatment was significantly different among three groups(P<0.05).The difference of HbA1c,leptin,adiponectin before and after treatment was significantly different among three groups(P<0.05).【Conclusion】The treatment of polyethylene glycol-loxenatide sequential combined with dapagliflozin for early obesity or overweight T2DM can decrease blood glucose and significantly reduce body weight,and improve insulin resistance,which may be the preferred treatment for early obesity or overweight T2DM.