单药或二联口服降糖药治疗血糖控制不佳的老年2型糖尿病患者加用达格列净的疗效及安全性  

Efficacy and safety of dapagliflozin on elderly T2DM patients with poorly controlled blood glucose under the treatment of single or combined oral hypoglycemic agents

作　　者：曾俊[1] 代文雪[1] 梅希[2] ZENG Jun;DAI Wen-xue;MEI Xi(Chengdu Medical College;Department of Endocrinology and Metabolism,the First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,Sichuan,China)

机构地区：[1]成都医学院 [2]成都医学院第一附属医院内分泌与代谢病科,四川成都610500

出　　处：《川北医学院学报》2021年第6期749-752,共4页Journal of North Sichuan Medical College

基　　金：成都医学院四川养老与老年健康协同创新中心项目(YLZBZ2008)。

摘　　要：目的:探讨单药或二联口服降糖药治疗血糖控制不佳的老年2型糖尿病患者加用达格列净的疗效及安全性。方法:选取46例老年2型糖尿病(T2DM)患者为研究对象,根据治疗方式不同分为Gli组和Gli+Met组,每组各23例。Gli组采用格列美脲联合达格列净治疗;Gli+Met组采用格列美脲联合二甲双胍再加用达格列净治疗,疗程24周;比较两组患者体重指数(BMI)、空腹血糖(FPG)、餐后2 h血糖(2 h PPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、餐后2 h胰岛素(2 h PINS)、胰岛β细胞功能指数(HOMA-β)、总胆固醇(TC)、甘油三酯(TG)、血尿酸(BUA)、血肌酐(Scr)、肾小球滤过率(eGFR)、尿微蛋白肌酐比(ACR)及不良反应。结果:治疗后,两组患者BMI、FPG、2 h PPG、HbA1c、Scr、BUA、ACR水平低于治疗前(P<0.05);FINS、2 h PINS、HOMA-β、eGFR高于治疗前(P<0.05),且GLi+Met组eGFR高于GLi组(P<0.05);不良反应发生率比较,差异无统计学意义(P>0.05)。结论:在格列美脲单用或与二甲双胍联用治疗血糖控制不佳的老年T2DM患者中加用达格列净可提高血糖控制效果,改善胰岛β细胞功能,且能保护肾脏,不增加不良反应的发生率,值得临床推广。Objective:To observe the efficacy and safety of dapagliflozin on elderly type 2 diabetes mellitus(T2DM)patients with poorly controlled blood glucose under the treatment of single or combined oral hypoglycemic agents.Methods:A total of 46 elderly T2DM patients with poorly controlled blood glucose were selected,they were divided into Gli group and Gli+Met group,23 cases in each group.The Gli group were on glimepiride monotherapy,and Gli+Met group were on combination therapy of glimepiride plus metformin sustained-release tablets(1500 mg/d).On this basis,patients in both groups were treated with dapagliflozin for 24 weeks.Body mass index(BMI),fasting plasma glucose(FPG),2 h postprandial plasma glucose(2 h PPG),glycosylated hemoglobin(HbA1c),fasting insulin(FINS),2h postprandial insulin(2hPINS)and isletsβCell function index(HOMA-β),total cholesterol(TC),triglyceride(TG),blood uric acid(BUA),serum creatinine(Scr),glomerular filtration rate(eGFR),urinary microprotein creatinine ratio(ACR)and adverse reactions were compared between the two groups.Results:After treatment,the levels of BMI,FPG,2 h PPG,HbA1c,Scr,BUA and ACR were lower than those before treatment(P<0.05),the levels of FINS,2 h PINS,HOMA-βand eGFR of the two groups were significantly higher than those before treatment(P<0.05).The EGFR of Gli+Met group was higher than that of Gli group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:In elderly T2DM patients with poorly controlled blood glucose under the treatment of glimepiride alone or combined with metformin,the combined application of dapagliflozin can improve the effect of glycemic control and the function of isletβ-cells,and protect the kidney,does not increase the incidence of adverse reactions,which can be worthy of clinical promotion.

关 键 词：2型糖尿病 达格列净 格列美脲 二甲双胍 血糖 

分 类 号：R587[医药卫生—内分泌]