Study On The Efficacy Of SGLT2 Inhibitors In The Treatment Of Type 2 Diabetes Mellitus Complicated With NAFLD

Objective:Non-alcoholic fatty liver disease(NAFLD)and Diabetes mellitus type 2(T2DM)are co-existing diseases.Type 2 Diabetes can accelerate the course of NAFLD.Meanwhile,NAFLD promotes metabolic disorders in type 2 diabetes.They work in concert and lead to bad results.The presence of both NAFLD and T2 DM increases the likelihood of diabetic complications,including macrovascular and microvascular complications,and increases the risk of adverse NAFLD outcomes,including cirrhosis,hepatocellular carcinoma,and death.NAFLD has become the largest chronic liver disease in China and the primary cause of abnormal liver biochemical indexes in health examination.Clinically,the treatment plan for patients with T2 DM combined with NAFLD is based on basic treatment such as diet adjustment,aerobic exercise,correction of lifestyle,etc.In addition,when patients suffer liver function damage,liver protective drugs are used to prevent the progression of liver disease.However,patients with T2 DM complicated with NAFLD have a long time of primary treatment,and some patients may suffer from asymptomatic liver function injury during primary treatment,and miss the optimal treatment opportunity.Sodium glucose cotransporter 2(SGLT2)inhibitors are a new type of oral hypoglycemic agents that reduce hyperglycemia by promoting urinary glucose excretion,improve insulin sensitivity and reduce liver fibrosis,etc.,and may directly or indirectly reduce liver function impairment in patients with diabetes.Therefore,this study aims to evaluate the clinical efficacy of SGLT2 inhibitors in the treatment of type 2 diabetes mellitus complicated with NAFLD from the aspects of blood glucose,glycosylated hemoglobin,alanine aminotransferase,glutamic oxalotransferase and so on,in order to provide a new idea for the treatment of type 2 diabetes mellitus complicated with NAFLD.Methods:A total of 118 patients with type 2 diabetes combined with NAFLD who were first diagnosed and admitted to the endocrinology department of a Grade A hospital in Xi ’an from September 2018 to January 2020 were involved,and they had not received any glucose-lowering therapy before diagnosis.Using a table of numbers,the patients were randomly divided into experimental group(60 cases)and control group(58 cases).The experimental group received metformin(2g/d)+ Dapagliflozin(10mg/d),and the control group received metformin(2g/d)+ acarbose(150mg/d).After 6 months of continuous treatment,Waist circumference,hip circumference,body mass index(BMI),blood pressure,fasting blood glucose(FPG),2-hour postprandial blood glucose(2h PG),hemoglobin glycoside(Hb A1c),glutamic-oxalacetic transaminase(AST),alanine transaminase(ALT),alkaline phosphatase(ALP),γ-glutamyltransferase(GGT),albumin(ALB),ferritin(FERR),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C)and other indicators were collected before and after treatment in 2 groups.SPSS25.0 software was used for statistical analysis.Results:1.Two groups of patients in gender,age,nationality,smoking history,waist,hip circumference,BMI,blood pressure,or hypertension,high uric acid hematic disease history,fasting blood glucose,blood sugar 2 hours after meal,glycosylated hemoglobin,cereal third transaminase,aspertate aminotransferase,ferritin,alkaline phosphatase,triglyceride,total cholesterol,APRI score(Aspartate Aminotransferase-to-platelet Ratio Index,FIB-4 Index(Fibrosis 4 Score),NAFLD Fibrosis Score(NFS)and other factors showed no statistical difference(P > 0.05).2.After 6 months of treatment,waist,hip circumference,BMI,blood pressure,fasting plasma glucose,postprandial 2 hours blood sugar,glycosylated hemoglobin,cereal third transaminase,aspertate aminotransferase,ferritin,alkaline phosphatase,triglycerides,APRI score,FIB-4 index in Dapagliflozin group was significantly decreased,the more statistically difference(P < 0.05).3.After 6 months of treatment,waist circumference,BMI,fasting blood glucose,2-hour postprandial blood glucose,and Hb A1 c in acarbose group were lower than those before treatment,with statistical difference(P<0.05).The hip circumference,blood pressure,alanine transaminase,glutamic-oxalacetic transaminase,ferritin,alkaline phosphatase,triglyceride,total cholesterol,APRI score,FIB-4 index and NFS were slightly lower than those before treatment,but there was no statistical difference(P>0.05).4.The change value of Dapagliflozin group before and after treatment was compared with that of acarbose group.The change in waist circumference,hip circumference,BMI,systolic blood pressure,glutamic-oxalacetic transaminase,glutamic-alanine transaminase,alkaline phosphatase,γ-glutamyltransferase,albumin,ferritin,Apri score,FIB-4 index,fasting blood glucose,2-hour postprandial blood glucose,and Hb A1 c were significantly different between the two groups(P<0.05).And Dapagliflozin group was higher than acarbose group.Conclusion:The hypoglycemic effect of metformin combined with Dapagliflozin was better than that of metformin combined with acarbose,and compared with the acarbose group,patients in the Dapagliflozin group were more likely to reach the blood glucose standard,and had better effects on reducing BMI,waist circumference and hip circumference.Compared with acarbose group,in patients with type 2 diabetes mellitus complicated with NAFLD,Dapagliflozin group not only reduced blood glucose,but also reduced blood pressure,alanine transaminase,glutamic-oxalacetic transaminase,ferritin,alkaline phosphatase,total cholesterol,triglyceride,and improved the liver function of patients.Dapagliflozin may be a potential treatment for liver injury in non-alcoholic fatty liver disease.