Effect Of Metformin Combined With DPP-4I On Thyroid Nodule Volume And Glucose And Lipid Metabolism In Patients With T2DM

Objective: Based on the discussion of the effects of a combination of Metformin and DPP-4i on thyroid volume,thyroid nodule(TN)volume,and the TI-RADS classification of nodule,thyroid function,blood glucose metabolism,insulin resistance,pancreatic β-cell function,blood lipids metabolism in patients with type 2diabetes(T2DM)and TN,this study provides new approaches for the treatment of T2 DM combined with TN.Methods: In this study,64 patients with T2 DM and TN who had been treated in the Department of Endocrinology,Yulin No.1 Hospital between January 2019 and January 2020 were selected as the research subjects,and they were divided into two groups by lottery,that is,experimental group(Metformin+DPP-4i)and the control group(Metformin).After excluding the patients who were lost to follow-up,a total of28 cases in the experimental group and 30 cases in the control group were followed up for one year to collect thyroid volume,TN volume,and thyroid nodule TI-RADS;thyroid function(FT3,FT4,TSH);blood glucose metabolism indexes(Hb A1 c,FPG,FINS);blood lipids(TC,TG,HDL-C,LDL-C).The t-test or non-parametric test is used for comparison within or between groups before and after treatment,and the chi-square test is used for rate comparison.The SPSS 26.0 software is used to process the above-mentioned data,and P<0.05 is statistically significant.Results: 1.In the group of a combination of Metformin and DPP-4i,before the treatment the thyroid volume is 11.01(8.40,14.76)m L,and after the treatment the thyroid volume is 10.70(7.37,17.48)m L(P<0.05),which may be more effective in reducing thyroid volume than Metformin(P<0.05).The volume of TN before the treatment is 0.43(0.26,0.58)m L,and the volume of TN after the treatment is 0.30(0.18,0.56)m L,which is smaller than before(P<0.05).There is no difference compared with the Metformin group;2.There are 2 cases(7.1%),13 cases(46.4%),9 cases(32.1%),and 4 cases(14.3%)of TR1-TR4 in the group of a combination of Metformin and DPP-4i before the treatment.After the treatment,there are 1 case of TR1(3.6%),18 cases of TR2(64.3%),6 cases of TR3(21.4%),3 cases of TR4(10.7%).There seems to be a tendency for the TI-RADS classification of some nodules to decrease after treatment,which is not statistically significant compared with that before the treatment(P>0.05).This trend appears to be slightly better than Metformin,but the difference was not statistically significant(P>0.05);3.In the group of a combination of Metformin and DPP-4i,TSH is 2.91 ? 0.81 u IU/m L before treatment,and 2.60?0.50 u IU/m L after treatment,which is lower than before(P<0.05).There is no significant change in FT3 and FT4 before and after the treatment(P>0.05),there is no significant and statistically difference in TSH,FT3,FT4 between the group of a combination of Metformin and DPP-4i and the Metformin group;4.A combination of Metformin and DPP-4i can reduce the FBG of T2 DM patients with TN by 2.05mmol/L(P<0.001),Hb A1 c by 1.01%(P<0.001),and FBG decreased by 0.66mmol/L(P<0.05)compared with the metformin group and Hb A1 c is 0.55%lower than that in the Metformin group(P<0.05);5.A combination of Metformin and DPP-4i can improve insulin resistance,HOMA-IR decreasing from 3.59(2.88,4.42)to 3.34(2.62,3.73)(P<0.05),which is not significantly different from the Metformin group.After the treatment,HOMA-βincreasing from 49.22(38.92,77.21)to 100.39(69.09,126.29)(P<0.05),which is significantly higher than that in the Metformin group(P<0.001);6.In the group of a combination of Metformin and DPP-4i,the rates before and after the treatment TG are respectively(2.24?1.11 vs 1.59?0.53,P<0.001)mmol/L,which is 0.65 mmol/L lower than that before the treatment;before and after the treatment,TC are respectively(4.30 ? 1.02 vs 3.94 ? 0.63,P=0.044<0.05)mmol/L,which decreased by 0.36 mmol/L compared to that before treatment;before and after the treatment,LDL-C are respectively(2.70?1.04 vs 2.16?0.55,P<0.001)mmol/L decreased by 0.53 mmol/L compared to that before treatment;before and after the treatment,HDL-C are respectively(1.093?0.20 vs 1.10?0.31,P=0.963>0.05)which is not significantly different from that before the treatment.Compared with the Metformin group,a combination of Metformin and DPP-4i can reduce TG by 0.28mmol/L and LDL-C by 0.30 mmol/L(P<0.05).Conclusion: 1.In patients with T2 DM and TN,a combination of Metformin and DPP-4i is superior to Metformin in reducing thyroid volume;2.In patients with T2 DM and TN,a combination of Metformin and DPP-4i is superior to Metformin alone in controlling the levels of FPB and Hb A1 c,improving pancreatic β-cell function,and reducing the levels of TG and LDL-C.3.In patients with T2 DM and TN,both Metformin combined with DPP-4i and Metformin alone can reduce TN volume and insulin resistance and TSH level,without changing FT3 and FT4 levels,and the difference was not statistically significant;4.In patients with T2 DM and TN,neither Metformin combined with DPP-4i nor Metformin alone degraded the classification of TI-RADS.