Effect Of Dagaglizin On Type 2 Diabetes Mellitus With Impaired Islet Function

Objective:To observe and analyze the effects of insulin and metformin combined with dapagliflozin,on type 2 diabetes patients with impaired islet function,difference of various clinical indicators.evaluate its clinical efficacy and safety,and provide a basis for clinical choice on the treatment of the above patients.Methods:A total of 120 inpatients with type 2 diabetes with impaired islet function in the Endocrinology Department of The Affiliated Hospital of Inner Mongolia University for Nationalities from March 2021 to October 2021 were selected.All patients randomly assigned into two group,60 patients in the control group,dapagliflozin group of 60 cases,all the patients accept insulin and metformin treatment with lifestyle intervention,Observation group combined with dapagliflozin 10 mg once a day,morning,the control group to continue the original hypoglycemic scheme,two groups are continuous 24 weeks of treatment.The indicators at each time point before treatment and after 12 and 24 weeks of treatment were as follows:Fasting blood glucose(FPG)、2hours postprandial blood glucose(2h PG)、Glycated hemoglobin(Hb A1c)、Insulin Dosage、Fasting insulin(FINS)、Fasting C-peptide(FCP)、2hours postprandial C-peptide(2h CP)、Triglyceride(TG)、Total cholesterol(TC)、High density lipoprotein cholesterol(HDL-C)、Low density lipoprotein cholesterol(LDL-C)、Systolic blood pressure(SBP)、Diastolic blood pressure(DBP)、Urinary albumin-to-Creatinine ratio(UACR)、Body mass Index(BMI),insulin early phase secretion index(△I30/△G30)、 insulin resistance index(HOMA-IR)、islet β cell function index(HOMA-β)was calculated by using the dynamic and static indexes of the measurement parameters and derivatives of oral glucose tolerance test(OGTT)and oral glucose post-insulin release test(OGIRT).The occurrence of adverse reactions during follow-up was recorded and timely treatment was given to ensure patient safety.Result:1、After 12 and 24 weeks of treatment,the level of BMI、SBP、DBP、UACR in dapagliflozin group was lower than that before treatment(P<0.01),Only BMI levels in the control group were lower than those before treatment(P<0.01)、There was no statistical difference in other indicators(P>0.05),and the above indexes in dapagliflozin group and control group have statistical difference at the same period(P<0.05).2、After 12 and 24 weeks of treatment,the level of FPG、2h PG、Hb A1c、Insulin Dosage in dapagliflozin group was lower than that before treatment(P<0.01),FPG、2h PG、Hb A1 c levels in the control group were lower than those before treatment(P<0.01)、There was no statistical difference in the dosage of insulin(P>0.05),and the above indicators in dapagliflozin group and control group have statistical difference at the same period(P<0.05).3、After 12 and 24 weeks of treatment,TG、TC、LDL-C levels in 2 groups were lower than before(P<0.01),the quantitative value of HDL-C in dapagliflozin group was higher than that before treatment(P<0.01),while the level of HDL-C in control group was higher than that before treatment at 24 weeks,merely(P<0.01),In addition,TG、TC、LDL-C was lower in dapagliflozin group than that in control group and HDL-C was higher than that in control group,with statistical significance(P<0.05).4、After 12 and 24 weeks of treatment,FINS、FCP levels in 2 groups were higher than before(P<0.01),the quantitative value of 2h CP in dapagliflozin group was higher than that before treatment(P<0.01),while the level of 2h CP in control group was higher than that before treatment at 24 weeks,merely(P < 0.01),and the FINS level of dapagliflozin group was higher than that of control group at 24 weeks,Other FCP、2h CP were higher than control group in the same period,with statistical significance(P<0.05).5、After 12 and 24 weeks of treatment,△I30/△G30 、HOMA-βlevels in both groups were higher than those before treatment(P<0.01),and the above indicators in dapagliflozin group and control group have statistical difference at the same period(P<0.05).6、After 12 and 24 weeks of treatment,while the level of H0MA-IR in dapagliflozin group was lower than that before treatment at 24 weeks(P<0.01),there was no statistical difference in HOMA-IR in control group(P > 0.05),and the HOMA-IR level of dapagliflozin group was lower than that of control group at 24 weeks,the difference was statistically significant(P<0.05).7、There was no obvious difference in the rate of adverse reactions between two groups(P>0.05).Conclusion:In T2 DM patients with impaired islet function,the combination of insulin and metformin with dapagliflozin can improve isletβcell function,and the early combination may benefit isletβcell function more.At the same time,it can cut down the quantitative value of FPG、2h PG and Hb A1c、Insulin dosage、BMI and blood pressure,improve blood lipids and reduce UACR.In addition,it reduces incidence of hypoglycemia,the urinary and reproductive system infection and ketoacidosis,and the overall safety is good.