Effect Of Dapagliflozin On Blood Glucose Fluctuation And Renal Protection In Patients With Type 2 Diabetic Kidney Disease

Objective:To investigate the effect of SGLT2 inhibitor dapgliflozin on blood glucose fluctuation and renal protection in patients with type 2 diabetic kidney disease.Methods:From August 2020 to March 2022(including the follow-up time),101 inpatients with type 2 diabetic kidney disease who had poor blood glucose control and had not used sodium glucose cotransporter-2(SGLT-2)inhibitor before were selected and divided into two groups,without dapagliflozin treatment as the control group(n=51)and dapagliflozin treatment as the observation group(n=50).The differences of blood glucose,fasting c-peptide level,blood glucose fluctuation and urinary albumin/creatinine ratio(UACR)between the two groups before and after treatment were compared.Results:After one month of treatment,the mean blood glucose(MBG),blood glucose variability(CV),mean blood glucose standard deviation(SBDG),mean blood glucose fluctuation(MAGE),mean absolute difference of daytime blood glucose(MODD),the incidences of hyperglycemia(dynamic blood glucose value>10 mmol/l)and hypoglycemia(dynamic blood glucose value<3.1 mmol/l)decreased in both groups,fasting c-peptide(FC-P)was higher than that before treatment,and the difference was statistically significant(P<0.05).And the observation group MBG[7.53±1.01 vs 9.04±1.59 mmol/l],CV[31.85±5.45 vs 38.37±3.30%],SDBG[2.49±0.80 vs 4.06±0.65 mmol/l],MAGE[3.46±1.35 vs 4.97±1.01 mmol/l],MODD[2.16±0.78 vs 4.11±0.97 mmol/l],incidence of hyperglycemia[3.00(0.00,18.00)vs 32.00(13.00,46.00)%],incidence of hypoglycemia[0.00(0.00,0.27)vs8.00(3.00,11.00)%],HbA1c[6.50(6.27,7.10)vs 8.70(7.00,10.00)%]was significantly lower than that in the control group(P<0.05),FC-P[1.78±0.49 vs 1.03±0.49 ng/ml]has a larger increase than that of the control group.In addition,the UACR of the two groups decreased 1 month,3 months and 6 months after treatment.In the observation group,after 1 month treatment[77.11(47.71,97.59)vs 117.12(77.67,233.9)mg/g],3 months after treatment[39.78(31.29,49.63)vs 100.41(63.37,219.57)mg/g],6 months after treatment[29.37(22.97,34.03)vs 78.32(40.58,200.43)mg/g],the UACR of the observation group decreased more significantly than that in the control group(P<0.05).Conclusion:SGLT-2 inhibitor dapagliflozin can reduce blood glucose and improve fasting C-peptide level in patients with type 2 diabetic kidney disease,which is more stable in blood glucose control and less adverse reactions such as hypoglycemia,and can also effectively reduce UACR.