达格列净对使用胰岛素联合利拉鲁肽或沙格列汀治疗不理想的2型糖尿病患者影响的研究
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摘要
目的分析应用达格列净和胰岛素泵联合利拉鲁肽或沙格列汀短期强化治疗T2DM患者的临床效果。方法选取2017年6月至2018年6月于我院内分泌科住院的T2DM患者87例,均以胰岛素泵注射同等剂量胰岛素,分为沙格列汀组(Sax,n=14),利拉鲁肽泵组(Lir,n=18),达格列净+沙格列汀组(Dap+Sax,n=21),达格列净+利拉鲁肽组(Dap+Lir,n=34)。检测治疗前和治疗12周后各组体重、SBP、DBP、FPG、2 hPG、HbA1c,计算胰岛素用量,比较各组治疗前后指标变化。结果与治疗前比较,各组FPG、2 hPG、HbA1c降低(P<0. 05);Dap+Sax组和Dap+Lir组DBP、SBP和总胰岛素量降低(P<0. 05)。治疗后,与Sax组比较,Dap+Sax组和Dap+Lir组FPG、2 hPG、总胰岛素量降低(P<0. 05);与Lir组比较,Dap+Sax组和Dap+Lir组DBP、总胰岛素量降低(P<0. 05)。Sax组和Dap+Sax组各发生1例低血糖,Dap+Sax组和Dap+Lir组各发现1例尿酮体阳性。结论达格列净联合胰岛素泵和利拉鲁肽或沙格列净短期强化降糖治疗效果良好,血压下降,平均总胰岛素用量降低,大剂量胰岛素带来的体重增加等不良反应减少。
Objective To analyze the clinical effect of Dapagliflozin combined with insulin pump and Liraglutide or Saxagliptin in the treatment of type 2 diabetes mellitus(T2DM).Methods 87 T2DM patients admitted to our hospital from June 2017 to June 2018 were divided into Saxagliptin group(Sax,n=14),Liraglutide group(Lir,n=18),Dapagliflozin+Saxagliptin group(Dap+Sax,n=21),Dapagliflozin+ Liraglutide group(Dap+Lir,n=34). Before and After 12 weeks of treatment,fasting blood glucose(FPG),2 h-postprandial blood glucose(2 hPG),glycosylated hemoglobin(HbA1c)levels,body weight,systolic blood pressure(SBP),diastolic blood pressure(DBP)and total insulin dosage among groups were compared.Results After 12 weeks of treatmen,the levels of FPG,2 hPG and HbA1c decreased significantly in each group(all P<0. 05);DBP,SBP and total insulin dosage decreased significantly in Dap+Sax group and Dap+Lir group(P<0. 05). Compared with Sax group,FPG,2 hPG and total insulin dosage decreased more significantly in Dap+Sax group and Dap+Lir group(P<0. 05). Compared with Lir group,DBP and total insulin dosage decreased significantly in Dap+Sax group and Dap+Lir group(P<0. 05). 1 case of hypoglycemia occurred in each of Sax group and Dap+Sax group. 1 case of urine ketone positive was found in each of Dap+Sax group and Dap+Lir group.Conclusion The combination of Dapagliflozin with insulin pump and Liraglutide or Saxagliptin not only has good hypoglycemic effect,but help to control blood pressure,reduce insulin dosage and reduce the adverse reactions such as weight gain caused by high-dose insulin.
Objective To analyze the clinical effect of Dapagliflozin combined with insulin pump and Liraglutide or Saxagliptin in the treatment of type 2 diabetes mellitus(T2DM).Methods 87 T2DM patients admitted to our hospital from June 2017 to June 2018 were divided into Saxagliptin group(Sax,n=14),Liraglutide group(Lir,n=18),Dapagliflozin+Saxagliptin group(Dap+Sax,n=21),Dapagliflozin+ Liraglutide group(Dap+Lir,n=34). Before and After 12 weeks of treatment,fasting blood glucose(FPG),2 h-postprandial blood glucose(2 hPG),glycosylated hemoglobin(HbA1c)levels,body weight,systolic blood pressure(SBP),diastolic blood pressure(DBP)and total insulin dosage among groups were compared.Results After 12 weeks of treatmen,the levels of FPG,2 hPG and HbA1c decreased significantly in each group(all P<0. 05);DBP,SBP and total insulin dosage decreased significantly in Dap+Sax group and Dap+Lir group(P<0. 05). Compared with Sax group,FPG,2 hPG and total insulin dosage decreased more significantly in Dap+Sax group and Dap+Lir group(P<0. 05). Compared with Lir group,DBP and total insulin dosage decreased significantly in Dap+Sax group and Dap+Lir group(P<0. 05). 1 case of hypoglycemia occurred in each of Sax group and Dap+Sax group. 1 case of urine ketone positive was found in each of Dap+Sax group and Dap+Lir group.Conclusion The combination of Dapagliflozin with insulin pump and Liraglutide or Saxagliptin not only has good hypoglycemic effect,but help to control blood pressure,reduce insulin dosage and reduce the adverse reactions such as weight gain caused by high-dose insulin.
引文
[1]许英,杨敏,关奉菊,等.初诊2型糖尿病患者胰岛素泵强化治疗的效果观察.慢性病学杂志,2017,19:135-137.
[2]黄小婷,陈延超.胰岛素泵强化治疗初诊2型糖尿病的临床观察及随访研究.中国社区医师医学专业,2011,13:75-76.
[3]张波,杨文英.钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)在治疗2型糖尿病中的有效性和安全性.中华内分泌代谢杂志,2016,32:171-176.
[4]石佳,方振威,林阳.达格列净对2型糖尿病患者血糖及心血管危险因素影响的Meta分析.中国临床药理学杂志,2015,31:116-118.
[5]Whitten JS.STEPS:Liraglutide(Saxenda)for weight loss.JAMA,2016,315:1161-1162.
[6]张方华,王霞,徐倩,等.沙格列汀并胰岛素泵治疗初诊2型糖尿病的效果.青岛大学医学院学报,2016,52:6-8.
[7]Ferrannini E,Ramos SJ,Salsali A,et al.Dapagliflozin monotherapy in type 2 diabetic patients with inadequate glycemic control by diet and exercise:a randomized,double-blind,placebo-controlled,phase 3 trial.Diabetes Care,2010,33:2217-2224.
[8]Ji L,Ma J,Li H,et al.Dapagliflozin as monotherapy in drugnaive Asian patients with type 2 diabetes mellitus:a randomized,blinded,prospective phase III study.Clin Ther,2014,36:84-100.e9.
[9]Bailey CJ,Morales Villegas EC,Woo V,et al.Efficacy and safety of dapagliflozin monotherapy in people with type 2 diabetes:a randomized double-blind placebo-controlled 102-week tri-al.Diabetic Med,2015,32:531-541.
[10]Araki E,Onishi Y,Asano M,et al.Efficacy and safety of dapagliflozin in addition to insulin therapy in Japanese patients with type 2 diabetes:results of the interim analysis of 16-week double-blind treatment period.J Diabetes Investig,2016,7:555-564.
[11]Wilding JP,Norwood P,T'Joen C,et al.A study of dapagliflozin in patients with type 2 diabetes receiving high doses of insulin plus insulin sensitizers:applicability of a novel insulin-inde-pendent treatment.Diabetes Care,2009,32:1656-1662.
[12]Leiter LA,Cefalu WT,de Bruin TW,et al.Dapagliflozin added to usual care in individuals with type 2 diabetes mellitus with preexisting cardiovascular disease:a 24-week,multicenter,ran-domized,double-blind,placebo-controlled study with a 28-week extension.J Am Geriatr Soc,2014,62:1252-1262.
[13]Vasilakou D,Karagiannis T,Athanasiadou E,et al.Sodium-glucose cotransporter 2 inhibitors for type 2 diabetes:a systematic review and meta-analysis.Ann Intern Med,2013,159:262-274.
[14]Bailey CJ,Gross JL,Pieters A,et al.Science direct-the lancet:effect of dapagliflozin in patients with type 2 diabetes who have inadequate glycaemic control with metformin:a randomised,double-blind,placebo-controlled trial.Lancet,2010,375:2223-2233.
[15]Heerspink HJL,Zeeuw DD,Wie L,et al.Dapagliflozin a glucose-regulating drug with diuretic properties in subjects with type2 diabetes.Diabetes Obes Metab,2013,15:853-862.
[2]黄小婷,陈延超.胰岛素泵强化治疗初诊2型糖尿病的临床观察及随访研究.中国社区医师医学专业,2011,13:75-76.
[3]张波,杨文英.钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)在治疗2型糖尿病中的有效性和安全性.中华内分泌代谢杂志,2016,32:171-176.
[4]石佳,方振威,林阳.达格列净对2型糖尿病患者血糖及心血管危险因素影响的Meta分析.中国临床药理学杂志,2015,31:116-118.
[5]Whitten JS.STEPS:Liraglutide(Saxenda)for weight loss.JAMA,2016,315:1161-1162.
[6]张方华,王霞,徐倩,等.沙格列汀并胰岛素泵治疗初诊2型糖尿病的效果.青岛大学医学院学报,2016,52:6-8.
[7]Ferrannini E,Ramos SJ,Salsali A,et al.Dapagliflozin monotherapy in type 2 diabetic patients with inadequate glycemic control by diet and exercise:a randomized,double-blind,placebo-controlled,phase 3 trial.Diabetes Care,2010,33:2217-2224.
[8]Ji L,Ma J,Li H,et al.Dapagliflozin as monotherapy in drugnaive Asian patients with type 2 diabetes mellitus:a randomized,blinded,prospective phase III study.Clin Ther,2014,36:84-100.e9.
[9]Bailey CJ,Morales Villegas EC,Woo V,et al.Efficacy and safety of dapagliflozin monotherapy in people with type 2 diabetes:a randomized double-blind placebo-controlled 102-week tri-al.Diabetic Med,2015,32:531-541.
[10]Araki E,Onishi Y,Asano M,et al.Efficacy and safety of dapagliflozin in addition to insulin therapy in Japanese patients with type 2 diabetes:results of the interim analysis of 16-week double-blind treatment period.J Diabetes Investig,2016,7:555-564.
[11]Wilding JP,Norwood P,T'Joen C,et al.A study of dapagliflozin in patients with type 2 diabetes receiving high doses of insulin plus insulin sensitizers:applicability of a novel insulin-inde-pendent treatment.Diabetes Care,2009,32:1656-1662.
[12]Leiter LA,Cefalu WT,de Bruin TW,et al.Dapagliflozin added to usual care in individuals with type 2 diabetes mellitus with preexisting cardiovascular disease:a 24-week,multicenter,ran-domized,double-blind,placebo-controlled study with a 28-week extension.J Am Geriatr Soc,2014,62:1252-1262.
[13]Vasilakou D,Karagiannis T,Athanasiadou E,et al.Sodium-glucose cotransporter 2 inhibitors for type 2 diabetes:a systematic review and meta-analysis.Ann Intern Med,2013,159:262-274.
[14]Bailey CJ,Gross JL,Pieters A,et al.Science direct-the lancet:effect of dapagliflozin in patients with type 2 diabetes who have inadequate glycaemic control with metformin:a randomised,double-blind,placebo-controlled trial.Lancet,2010,375:2223-2233.
[15]Heerspink HJL,Zeeuw DD,Wie L,et al.Dapagliflozin a glucose-regulating drug with diuretic properties in subjects with type2 diabetes.Diabetes Obes Metab,2013,15:853-862.