| Background and Aims:The morbidity of type 2 diabetes is increasing year by year and has become one of the most important metabolic diseases in the world.Diabetes can not only cause acute complications such as diabetic ketoacidosis、hyperosmolar hyperglycemic state and so on,but also lead to a variety of diabetes-related chronic complications which cause a damage to microvascular,macrovascular and nervous system in long-term hyperglycemia,In recent years,osteoporosis has gradually become one of the important complications of diabetes.Sodium glucose transporter 2(SGLT2)inhibitor is a new class of hypoglycemic agents.These agents reduce reabsorption of glucose in the kidneys and facilitate its excretion in the urine by inhibiting the SGLT2 located in the proximal convoluted tubule,thereby lowering glucose levels independently of insulin action.dapagliflozin as the first approved SGLT2 inhibitor in China is widely used.However,Considering the hypoglycemic mechanism,it may affect the excretion of electrolytes such as calcium,magnesium and phosphorus,thus affecting bone metabolism which can lead to increased risk of osteoporosis and fracture.In this study,we evaluate the metabolic indexes of blood glucose,blood lipid,bone metabolism and inflammatory factors to reveal the the benefits and risks of dapagliflozin in patients with type 2 diabetes.Methods:Our study adopt self-contrast method.13 patients with T2DM(7 males and 6 females;aged 36-72 years)in the outpatient department of endocrinology of Shandong Provincial Hospital from July 2020 to November 2020.Patients were given dapagliflozin 10mg/day.The height,weight,waist circumference,hip circumference,blood pressure and serum indexes of patients were detected at baseline and 12 weeks after the start of the experiment.In clinical laboratory for fasting glucose,glycosylated hemoglobin,fasting insulin,triglycerides,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,alkaline phosphatase,urea nitrogen,creatinine,calcitonin,parathyroid hormone,osteocalcin molecular fragment,Beta-collagen in the n-terminal special sequence,total collagen type I amino terminal extension of the peptide,25-hydroxy vitaminD;IL-1,IL-8,FGF23,MPO,8-OHDG and other indexes were determined in the laboratory.Results:1.After 12 weeks of treatment with dapagliflozin,the levels of FBG and HbAlc was decreased(P<0.05).HOMA-β showed no significant difference after treatment,but showed a slight upward trend;HOMA-IR also showed no significant difference,but showed a slight downward trend compared with baseline.2.After 12 weeks of treatment with dapagliflozin,the body weight,BMI and waist circumference of the patients with type 2 diabetes decreased significantly,and the level of HDL increased,while the hip circumference,TG,CHOL and LDL had no significant differences.3.After 12 weeks of treatment wit dapagliflozin,the SBP and DBP were significantly decreased(P<0.05).4.Serum magnesium levels and FGF23 levels increased in patients with type 2 diabetes after 12 weeks of dapagliflozin treatment(both P<0.05).The level of PTH increased,but there was no significant difference on PTH(P=0.18).The level of N-mid decreased,but the levels of P1NP,β-CTX and ALP did not change significantly.5.After 12 weeks of treatment with dapagliflozin,IL-1 levels in patients with type 2 diabetes decreased significantly(P<0.05),while IL-8,MPO and 8-OHDG had no significant changes before and after the treatment.Conclusion:1.Dapagliflozin can effectively reduce the blood glucose level in patients with type 2 diabetes,but has slightly improvement in islet secretion function and insulin resistance within 12 weeks.2.Dapagliflozin can significantly reduce blood pressure and body weight and decrease abdominal obesity,but has a slight effect on lipid metabolism.3.Dapagliflozin can increase serum magnesium,increase the level of FGF23,decrease the level of 1,25-(OH)D3,and potentially affect the metabolism of blood phosphorus.Dapagliflozin can also reduce the level of N-MID and inhibit the mineralization process of bone formation.4.dapagliflozin can reduce IL-1 level,and has effect on the reduction of chronic inflammation of bone metabolism environment caused by diabetes. |
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