| Objective In this study,for T2 DM patients treated with other hypoglycemic drugs combined with dapagliflozin in the real world,the changes of anthropometric indexes,evaluation indexes of insulin resistance and obesity and biochemical indexes before and after treatment were compared.Meanwhile,the differences in RBC parameters and blood glucose before and after treatment in T2 DM patients treated with or without dapagliflozin were also discussed,and the effects of dapagliflozin on RBC parameters were further analyzed under different blood glucose control conditions and with or without vascular complications,to explore whether the effects of dapagliflozin on RBC could be a potential mechanism for improving complications besides hypoglycemia.Methods The data in this study were collected from the Yidu Cloud data platform of the Hospital.The study subjects were 268 T2 DM patients who met the inclusion criteria(at least taking dapagliflozin 10 mg once a day)from January2019 to February 2023,and 9 patients were completely lost to follow-up.A total of 93 T2 DM patients who were not treated with dapagliflozin at the same time and whose age and gender composition were similar to those in the observation group were selected as the control group.The hypoglycemic drugs used by the above subjects included insulin,biguanides,glucosidase inhibitor,sulfonylureas,DPP-4 inhibitors and GLP-1 receptor agonists,among which metformin accounted for more than 80%.Patients treated with dapagliflozin for more than 6months were divided into group A(n=179),and 167 patients had complete blood routine data before and after treatment.Patients treated from 4 to 6 months were divided into Group B(n=80),with 66 patients having complete blood routine tests.Group C(n=74)was not treated with dapagliflozin for more than 6 months,and group D(n=19)was treated between 4 and 6months.233 patients in groups A and B were grouped according to the type of diabetic vascular disease.Patients without vascular disease were in group E(n=66),patients with simple macrovascular disease were in group F(n=107),patients with simple microvascular disease were in group G(n=29),and patients with macrovascular disease combined with microvascular disease were in group H(n=31).Using the same method,93 patients in groups C and D with blood routine tests were divided into two groups: patients without vascular lesions(group I)(n=26),and patients with simple large vascular lesions(group J)(n=42).Anthropometric indicators of patients before and after the study: Body mass index(BMI),waist circumference,hip circumference;The evaluation indexes of insulin resistance and obesity were: visceral fat Index(VAI),fat storage index(LAP),fasting triglyceride glucose index(Ty G Index),triglyceride/high-density lipoprotein cholesterol ratio(TG/HDL-C ratio);Islet beta cell function index(HOMA-β),insulin resistance index(HOMA-IR);albumin/creatinine ratio(UACR),estimated glomerular filtration rate(e GFR)and biochemical indicators such as blood lipid were collected and analyzed.Red blood cell parameters before and after treatment were collected: Red blood cell count(RBC),hematocrit(HCT),hemoglobin determination(HB),mean volume of red blood cell(MCV),distribution width of red blood cell(RDW),coefficient of variation of distribution width of red blood cell(RDW-CV),standard deviation of distribution width of red blood cell(RDW-SD),fasting blood glucose(FPG),glycosylated hemoglobin(Hb A1c)and other data to compare the changes in the above indicators.Results(1)The majority of T2 DM patients in Group A(combined with dapagliflozin for ≥ 6 months)and Group B(combined with dapagliflozin for4-6 months)were male(>70%),with nearly half of the patients having a disease course of more than 10 years;Compared with before treatment,BMI(t=4.245,P<0.001),waist circumference(t=4.973,P<0.001),hip circumference(t=3.199,P<0.001),waist-hip ratio(t=2.280,P=0.025)and Hb A1c(z=-2.640,P=0.008)after treatment were decreased,and the difference was statistically significant(all P<0.05).After treatment,FPG(t=2.689,P=0.008),120 min plasma glucose(120min PG)(t=2.242,P=0.034),and e GFR(z=-2.148,P=0.032)in Group A decreased compared to baseline,while Serum creatinine(Scr)(t=-2.231,P=0.028)increased,with a statistically significant difference(P<0.05);Ty G index(t=2.304,P=0.029),TG/HDL-C ratio(z=-3.103,P=0.002),VAI(z=-3.254,P=0.001)and LAP(z=-3.708,P<0.001)were all decreased after treatment in group B,the difference was statistically significant(P<0.05).After treatment,total cholesterol(TC)and triglyceride(TG)of group A and B showed a downward trend compared with baseline,but the difference was not significant(P>0.05),high-density lipoprotein cholesterol(HDL-c)in group A(z=-3.350,P=0.001)increased after treatment,and low-density lipoprotein cholesterol(LDL-c)in group B(t=-3.793,P=0.001)decreased after treatment,the difference was statistically significant(P<0.05).After treatment,Hb A1 c decreased from baseline in groups C and D,but the difference was not significant(P>0.05).(2)After grouping group A according to baseline Hb A1 c level,it was observed that RBC,HCT,HB and RDW-CV in group Hb A1c≥9% at baseline after dapagliflozin treatment had an increasing trend,but there was no statistical significance(P≥0.05).RBC(t=-4.375,P<0.001),HCT(t=-4.995,P<0.001),HB(t=-5.291,P<0.001)were increased in Hb A1c<9% group after treatment(all P<0.05).Group A after treatment Hb A1 c standard group(Hb A1c<7%)RBC(t=-4.428,P<0.001),HCT(t=-4.841,P<0.001),HB(t=-3.951,P<0.001),RDW-CV(z=-2.226,P=0.026)were all increased(P<0.05).HCT(t=-2.649,P=0.010),HB(t=-3.629,P<0.001)and MCV(t=-2.066,P=0.042)were increased in the non-conforming Hb A1 c group(Hb A1c≥7%)(all P<0.05),while RBC level was not statistically significant(P>0.05).RBC,HCT and HB increased after treatment in group A and B(P<0.05),MCV(t=-3.60,P<0.001),RDW-CV(z=-4.20,P<0.001),RDW-SD(z=-2.61,P=0.009)increased in group A after treatment(P<0.05).(3)RBC and HB decreased in group C(≥6 months without combined dapagliflozin treatment)and group D(4-6 months without combined dapagliflozin treatment)after drug treatment(P<0.05);In group C,HCT(t=3.064,P=0.003)decreased and MCV increased(t=-4.116,P<0.001)(P<0.05),the results were consistent regardless of whether Hb A1 c reached the standard;There was no statistical significance in the decrease of HCT and increase of MCV in group D(P>0.05).In addition,there was a positive correlation between the difference before and after RBC and the difference before and after Hb A1 c in group C after treatment(r=0.285,P=0.014).(4)Compared with before treatment,RBC(t=-3.239,P=0.002),HCT(t=-3.898,P<0.001),HB(t=-6.696,P<0.001),and MCV(t=-2.095,P=0.040)in group E(no vascular lesions after treatment with dapagliflozin)increased after treatment(all P<0.05).Group F(combined with dapagliflozin for great vascular lesions)RBC(t=-4.670,P<0.001),HCT(t=-5.973,P<0.001),HB(t=-7.174,P<0.001),MCV(t=-2.547,P=0.012),RDW-CV(z=-4.475,P<0.001),RDW-SD(z=-2.403,P=0.016)were increased(all P<0.05).RBC(t=-3.444,P=0.002),HCT(t=-4.454,P<0.001),HB(t=-3.445,P=0.002)were increased in group G(combined with dapagliflozin for microvascular lesions)(P<0.05).RBC(t=-2.414,P=0.022)and HCT(t=-2.260,P=0.031)in group H(combined with dapagliflozin for treatment of macrovascular disease with microvascular disease)were increased(P<0.05).The RBC,HCT and HB of group I(without combined treatment with dapagliflozin and without vascular disease)decreased slightly after treatment,and the difference was not statistically significant(P>0.05);MCV(t=-2.996,P=0.006)was increased(P<0.05).The RBC(z=-3.721,P<0.001),HCT(z=-2.520,P=0.012)and HB(z=-5.646,P<0.001)decreased in group J(without combined treatment with dapagliflozin for macrovascular lesions),while the MCV(t=-3.626,P=0.001)increased(P<0.05).Conclusion(1)This real-world before-and-after controlled study in T2 DM patients showed significant reductions in Hb A1 c,BMI,waist circumference,hip circumference,and waist-to-hip ratio in patients treated with combined dapagliflozin.(2)RBC count,HCT and HB increased from baseline after combined treatment with dapagliflozin,and did not decrease with the extension of observation time;dapagliflozin increased RBC counts more significantly when glycemic control was achieved.(3)RBC count decreased under hyperglycemia condition,and the effect of dapagliflozin on increasing RBC count was masked.(4)RBC,MCV and RDW increased in T2 DM patients with vascular complications after combined treatment with dapagliflozin,suggesting that the increase in RDW after combined treatment with dapagliflozin may be related to the promotion of RBC generation.daggliflozin increases the number of RBC,changes the volume and distribution width of red blood cells,and may be related to the decrease in RBC membrane deformability. |
PDF Full Text Request