达格列净治疗2型糖尿病的临床研究

孙伟; 王飞; 杨光束; 于影

doi:10.16766/j.cnki.issn.1674-4152.002046

达格列净治疗2型糖尿病的临床研究

doi: 10.16766/j.cnki.issn.1674-4152.002046

孙伟¹,
王飞¹,
杨光束¹,
于影^2, ,

1.
淮北市人民医院内分泌科, 安徽淮北 235000
2.
蚌埠医学院生理学教研室，安徽蚌埠 233000

基金项目:

安徽省教育厅自然科学重点项目 KJ2019A0306

淮北市2018年科技攻关计划 rj201810

详细信息

通讯作者:
于影，E-mail: yuying2011@126.com

中图分类号: R587.1 R977.15
计量
- 文章访问数: 305
- HTML全文浏览量: 219
- PDF下载量: 8
- 被引次数: 0
出版历程
- 收稿日期: 2021-07-11
- 网络出版日期: 2022-02-16

Clinical efficacy of dapagliflozin in the treatment of type 2 diabetes mellitus

1.
Department of Endocrinology, Huaibei People's Hospital, Huaibei, Anhui 235000, China

摘要

摘要: 目的观察达格列净联合预混胰岛素治疗血糖控制较差的2型糖尿病患者的临床疗效、安全性及耐受性。方法选择2019年1月—2020年3月期间于淮北市人民医院住院的60例注射门冬胰岛素30与二甲双胍口服联合治疗血糖控制不达标的2型糖尿病患者, 根据临床治疗方法分为2组，每组30例, 对照组使用门冬胰岛素30注射联合二甲双胍口服，观察组在对照组基础上加服达格列净片，2组患者在治疗期间监测血糖，根据血糖水平调整胰岛素剂量, 比较2组患者空腹血糖、餐后2小时血糖、糖化血红蛋白、血糖达标时间、胰岛素用量、低血糖事件、体重变化及患者出现的不良反应情况。结果治疗12周后，对照组与观察组的空腹血糖、餐后2小时血糖、糖化血红蛋白均低于治疗前(P < 0.05)，观察组的空腹血糖(6.60±0.52)mmol/L、血糖达标时间(6.67±1.60)d、胰岛素用量(40.17±7.01)U/d、体重指数23.41±2.11均低于对照组，差异有统计学意义(P < 0.05)。观察组2例患者出现低血糖，对照组有8例患者出现低血糖，对照组患者的低血糖发生率高于观察组，差异有统计学意义(P < 0.05)。结论在2型糖尿病患者中应用达格列净联合预混胰岛素降糖效果显著, 具有减轻体重优势，患者安全性和耐受性好。
- 2型糖尿病 /
- 达格列净 /
- 门冬胰岛素30 /
- 钠葡萄糖协同转运蛋白2抑制剂
Abstract: Objective To observe the clinical therapeutic effect, safety and tolerance of dapagliflozin combined with premix insulin in treatment for type 2 diabetes mellitus with poor glucose control. Methods Total 60 patients with type 2 diabetes mellitus with poor glycemic control treated with oral insulin aspartate 30 and metformin were treated in Huaibei People's Hospital from January 2019 to March 2020 were divided into 2 groups, 30 cases in each group according to the clinical treatment. The observation group received the treatment of dapagliflozin combined with insulin aspart 30 and metformin, and the control group was only treated with insulin aspart 30 and metformin. Two groups of the patients adjust insulin dose according to the level of plasma glucose. The patient's fasting plasma glucose (FPG), 2-hour postprandial blood glucose (2hPG), hemoglobin A1c (HbA1c), plasma glucose controlling time, insulin doses, presence of hypoglycemic events, weight change and adverse reaction were recorded. Results After 12 weeks of treatment, the fasting plasma glucose, 2-hour postprandial blood glucose and hemoglobin A1c in the two groups were lower than before treatment (P < 0.05). Fasting plasma glucose (6.60±0.52) mmol/L, plasma glucose controlling time (6.67±1.60) d, insulin dosage (40.17±7.01) U/d and body mass index (23.41±2.11) in the observation group were lower than the control group (P < 0.05). Two patients in the observation group had hypoglycemia, while eight patients in the control group had hypoglycemia. The incidence of hypoglycemia in the control group was higher than that in the observation group. There was statistical difference between the two groups (P < 0.05). Conclusion The clinical efficacy of dapagliflozin combined with premix insulin is significant in the treatment of type 2 diabetes. It has the advantages of weight loss, good safety and tolerance.
- Type 2 diabetes mellitus /
- Dapagliflozin /
- Insulin aspart 30 /
- Sodium glucose co transporter 2 inhibitor

HTML全文

表 1 2组2型糖尿病患者基本临床资料比较(x±s)

组别	例数	年龄(岁)	病程(年)	空腹血糖(mmol/L)	餐后2小时血糖(mmol/L)	BMI	HbA1c(%)	SBP (mm Hg)
观察组	30	55.57±10.58	7.87±3.23	9.41±1.59	14.07±2.37	25.06±2.67	8.60±1.42	130.43±12.78
对照组	30	56.70±8.84	7.53±2.76	9.07±1.45	13.85±2.45	24.43±2.53	8.31±1.11	124.93±14.26
t值		0.450	0.429	0.868	0.351	0.943	0.902	1.574
P值		0.654	0.669	0.389	0.727	0.350	0.371	0.121

组别	例数	DBP (mm Hg)	TG (mmol/L)	TC (mmol/L)	LDC (mmol/L)	HDL-C (mmol/L)	胰岛素剂量(U)	空腹C肽(nmol/L)
观察组	30	82.03±8.62	2.13±1.19	4.99±1.19	2.96±0.72	1.18±0.34	43.73±5.26	1.03±0.12
对照组	30	81.17±9.62	1.63±1.04	4.49±0.79	2.87±0.74	1.22±0.35	42.67±5.52	1.08±0.15
t值		0.367	1.728	1.911	0.465	0.262	0.766	1.415
P值		0.715	0.089	0.062	0.643	0.794	0.447	0.162
注：1 mm Hg=0.133 kPa。

下载: 导出CSV

表 2 2组2型糖尿病患者治疗前后空腹血糖、餐后2小时血糖、糖化血红蛋白比较(x±s)

组别	例数	空腹血糖(mmol/L)		餐后2小时血糖(mmol/L)		HbA1c(%)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	30	9.41±1.59	6.60±0.52^a	14.07±2.37	9.66±0.99^a	8.60±1.42	6.94±0.84^a
对照组	30	9.07±1.45	6.86±0.30^a	13.85±2.45	9.22±0.70^a	8.31±1.11	7.03±0.60^a
t值		0.868	2.384	0.351	2.017	0.902	0.512
P值		0.389	0.020	0.727	0.049	0.371	0.611
注：与治疗前比较, ^aP<0.05。

下载: 导出CSV

表 3 2组2型糖尿病患者治疗后临床资料比较(x±s)

组别	例数	血糖达标时间(d)	血糖(mmol/L)		BMI	胰岛素用量(U/d)
组别	例数	血糖达标时间(d)	空腹	餐后	BMI	胰岛素用量(U/d)
观察组	30	6.67±1.60	6.60±0.52	9.66±0.99	23.41±2.11	40.17±7.01
对照组	30	7.57±1.63	6.86±0.30	9.22±0.70	24.75±2.69	48.73±6.74
t值		2.153	2.384	2.017	2.132	4.827
P值		0.035	0.020	0.049	0.037	＜0.001

下载: 导出CSV

参考文献(16)

[1]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版)[J]. 中华糖尿病杂志, 2018, 10(1): 4-67. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK201804009.htm
[2]	CRISMAN M, LUCCHETTA L, LUETHI N, et al. The effect of insulin administration on c-peptide in critically ill patients with type 2 diabetes[J]. Ann Intensive Care, 2017, 7(1): 50. doi: 10.1186/s13613-017-0274-5
[3]	胡琛亮, 奚宇, 王玉婵, 等. 对新诊断2型糖尿病患者为期12周多次胰岛素类似物皮下注射强化治疗的疗效观察[J]. 中华全科医学, 2019, 17(10): 1691-1693, 1721. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201910022.htm
[4]	SHARMA R, WILKINSON L, VRAZIC H, et al. Comparative efficacy and safety of once-weekly semaglutide and sodium-glucose co-transporter 2 inhibitors (SGLT2) in type 2 diabetic patients inadequately controlled with Misinform chemotherapy[J]. Curr Med Res Opin, 2018, 34(9): 1595-1603. doi: 10.1080/03007995.2018.1476332
[5]	ZINMAN B, BHOSEKAR V, BUSCH R, et al. Semaglutide once weekly as add-on to SGLT-2 inhibitor therapy in type 2 diabetes (SUSTAIN 9): a randomised, placebo-controlled trial[J]. Lancet Diabetes Crinoline, 2019, 7(5): 356-367. doi: 10.1016/S2213-8587(19)30066-X
[6]	葛均波, 徐永健. 内科学[M]. 9版. 北京: 人民卫生出版社, 2018: 733-734.
[7]	刘烈华, 李延兵. 人生难再少, 强化莫失机——2型糖尿病防治策略的思考[J]. 中华糖尿病杂志, 2020, 12(7): 440-444. doi: 10.3760/cma.j.cn115791-20200210-00061
[8]	王玉荣, 许晨, 董其娟. 达格列净和西格列汀辅助治疗超重肥胖及胰岛素治疗不佳T2DM患者研究[J]. 现代医药卫生, 2021, 37(2): 279-281. doi: 10.3969/j.issn.1009-5519.2021.02.028
[9]	刘建军, 刘静. 糖尿病患者应用胰岛素后致严重高胰岛素血症1例[J]. 中国实用医药, 2018, 13(6): 138-139. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA201806087.htm
[10]	宋艳东, 李志忠, 张京梅, 等. 钠-葡萄糖共转运蛋白2抑制剂对2型糖尿病患者的心血管保护作用[J]. 中国医药, 2019, 14(11): 1746-1749. doi: 10.3760/j.issn.1673-4777.2019.11.036
[11]	CHO Y K, KANG Y M, LEE S E, et al. Efficacy and safety of combination therapy with SGLT2 and DPP4 inhibitors in the treatment of type 2 diabetes: A systematic review and meta-analysis[J]. Diabetes Metab, 2018, 44(5): 393-401. doi: 10.1016/j.diabet.2018.01.011
[12]	高芳芳, 张萍, 钟兴, 等. 达格列净对血糖控制不佳的2型糖尿病患者血糖波动的影响[J]. 山东医药, 2020, 60(14): 48-50. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYY202014014.htm
[13]	陈显英, 符茂雄. 从循证医学角度看致体重降低降糖药物的长期有效性和安全性[J]. 药品评价, 2018, 15(3): 29-33, 64. https://www.cnki.com.cn/Article/CJFDTOTAL-YPPJ201803007.htm
[14]	YANG L, ZHANG L, HE H, et al. Efficacious and safety of sodium-glucose co transporter 2 inhibitors in east asians with type 2 diabetes: a systematic review and meta-analysis[J]. Diabetes Ther, 2019, 10(8): 1921-1934. doi: 10.1007/s13300-019-0674-7
[15]	ZHANG L, ZHANG M, LV Q G, et al. Efficacy and safety of sodium-glucose co transporter 2 inhibitors in patients with type 2 diabetes and moderate renal function impairment: A systematic review and meta-analysis[J]. Diabetes Res Clin Pract, 2018, 140(7): 295-303.
[16]	徐爱花, 黄建胜, 何银辉, 等. 达格列净片治疗2型糖尿病血糖控制不佳患者的疗效与低血糖风险观察[J]. 中华全科医学, 2020, 18(9): 1500-1503, 1526. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202009020.htm