| Objective:Observe and analyze the changes of various clinical indexes of dulaglutide in type 2 diabetes mellitus with impaired islet beta cells function,and evaluate the efficacy and safety of dulaglutide,to provide a better therapeutic regimen for type 2diabetic patients with impaired islet beta cells function.Method:From June 2019 to September 2020,a total of 150 type 2 diabetic patients with impaired islet beta cells function who were admitted to the Endocrinology Department of the Second Hospital of Jilin University were collected.Patients were randomly divided into two groups.There were respectively 75 cases in the dulaglutide treatment group and the insulin treatment group.The dulaglutide treatment group was the experimental group while the insulin treatment group was the control group.Patients in both groups received diabete-related health knowledge education,diabetic diet and exercise guidance.On the basis of oral metformin tablets(Glucophage)0.5g,3 times a day,the dulaglutide treatment group was given subcutaneous injection of dulaglutide injection(Trulicity),1.5mg/time,once a week;meanwhile,the insulin treatment group was treated with insulin glargine(Lantus),and timely according the blood glucose level to adjust the insulin dose so that both FPG and 2hPG were within the range of blood glucose control target.Patients in both groups were treated continuously for 12 weeks.Record all various indicators before and after treatment,including FPG,2hPG,HbA1c,FINS,FCP,2hCP,TG,TC,HDL-C,LDL-C,homocysteine,body weight,waist circumference,BMI,hypoglycemia incidence rate,incidence rate of adverse reactions,and calculate HOMA-IR,HOMA-β,ΔCP.Result:The study included 150 patients in all,8 of whom were dropped out halfway,and finally completed follow-up of 142 patients,including 70 cases in the dulaglutide treatment group and 72 cases in the insulin treatment group.The general clinical data and various examination indexes of the dulaglutide treatment group and the insulin treatment group were not statistically significant before treatment(p>0.05).After 12 weeks of treatment,the body weight,waist circumference and BMI of the dulaglutide treatment group and the insulin treatment group were decreased(p<0.05).Moreover,the decline is more pronounced in the dulaglutide treatment group compared with the insulin treatment group(p<0.05).The FPG,2hPG,HbA1c of the dulaglutide treatment group and the insulin treatment group after 12 weeks of treatment were significantly reduced(p<0.05),and the indexes of the dulaglutide treatment group decreased significantly compared with the insulin treatment group(p<0.05).The FCP in both groups was higher after 12 weeks of treatment(p<0.05),and the dulaglutide treatment group was significantly higher than the insulin treatment group(p<0.05).Compared with before treatment,the 2hCP level of patients in the dulaglutide treatment group increased after 12 weeks of treatment(p<0.05),at the same time after 12 weeks of treatment in the insulin treatment group was not significantly different from that before treatment(p>0.05),the dulaglutide treatment group was higher than the insulin treatment group(p<0.05).After 12 weeks of treatment,the ?CP in the dulaglutide treatment group increased(p<0.05),however in the insulin treatment group was not statistically significant(p>0.05),the dulaglutide treatment group was higher than that of the insulin treatment group(p<0.05).The HOMA-β in both groups significantly increased after 12 weeks of treatment(p<0.05),and the increase of the dulaglutide treatment group was even greater(p<0.05).The HOMA-IR of the two groups significantly decreased after 12 weeks of treatment(p<0.05),furthermore compared with the insulin treatment group,the dulaglutide treatment group decreased significantly(p<0.05).After 12 weeks of treatment,the levels of TG,TC and LDL-C in both groups were significantly reduced(p<0.05),and the dulaglutide treatment group was significantly lower than that of the insulin treatment group,with statistical differences(p<0.05).After 12 weeks of treatment,the level of HDL-C in the dulaglutide treatment group markedly increased(p<0.05),as well as there is no noticeable change in the insulin treatment group(p>0.05),and the dulaglutide treatment group was higher compared with the insulin treatment group(p<0.05).After 12 weeks of treatment,the homocysteine level in the dulaglutide treatment group decreased(p<0.05),whereas there was no obvious change in the insulin treatment group(p>0.05),and the dulaglutide treatment group was significantly lower(p<0.05).In the incidence of hypoglycemia during the treatment process,there was no statistical difference between the two groups(p>0.05).There was a statistical difference between the dulaglutide treatment group and the insulin treatment group in terms of adverse reactions incidence during treatment,the dulaglutide treatment group was higher than that in the insulin treatment group(p<0.05).Conclusions:(1)Dulaglutide is effective at reducing body weight and ameliorating abdominal obesity.The treatment of dulaglutide once a week is associated with reduction in HbA1c and improvements in both FPG and 2hPG.Dulaglutide also has better effects on improving the blood lipid profile and regulating blood lipid metabolism disorders.In addition,dulaglutide is well tolerated and doesn’t increase the incidence of hypoglycemia.(2)For T2DM patients with impaired islet beta cells function,once-weekly dulaglutide injection can more effectively reduce insulin resistance and improve overall pancreatic beta cells function compared with insulin glargine.Additionally,the combination of dulaglutide and metformin may be a better choice for treating diabetes mellitus,and the early application of this combination may benefit the function of islet cells more. |
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