Effect Of Dapagliflozin On Visceral Fat Index In Overweight Type 2 Diabetes Patients

Objective:To investigate the effect of dapagliflozin on lipid metabolism and visceral fat index(VAI)in overweight type 2 diabetes patients.Methods:We selected 217 patients with type 2 diabetes who were hospitalized in Yantai Yuhuangding Hospital affiliated to Qingdao University from September 2020 to November 2021.All patients had BMI≥24kg/m2.Before admission,two or more hypoglycemic drugs were used,but the blood sugar was still poorly controlled,and HbA1c≥7.0%.The hypoglycemic drugs were selected according to the patients’own will,and were divided into two groups according to whether the hypoglycemic drugs included dapagliflozin.observation group(n=108)and control group(n=109).All patients signed informed consent,and the research scheme was reviewed and approved by the Ethics Committee of Yantai Yuhuangding Hospital affiliated to Qingdao University.Patients in both groups received diabetes education.The control group adjusted insulin or oral hypoglycemic drugs or other non-SGLT-2 inhibitors.The observation group was treated with dapagliflozin on the basis of original insulin or oral hypoglycemic drugs,once a day,each time 10mg.The patients in the observation group were followed up for 12 months.Record the patient’s sex,age,body weight,BMI(body mass index),waist circumference,hip circumference,FPG(fasting blood glucose),HbA1c(glycosylated hemoglobin),systolic blood pressure,diastolic blood pressure,TC(total cholesterol),TG(triglyceride),LDL-C(low density lipoprotein cholesterol),ALT(glutamic pyruvic transaminase),AST(glutamic oxaloacetic transaminase),uric acid,creatinine,eGFR(glomerular filtration rate),VAI(visceral fat index),CIMT(intima-media thickness of carotid artery)changes.Results:1.In the dapagliflozin group,3 patients had urinary tract infection,2 patients had digestive system symptoms,1 patient changed the hypoglycemic regimen and 1 patient lost follow-up.In the control group,1 patient had diabetic ketoacidosis and 2 patients had digestive system symptoms.A total of 207 patients completed the study.The mean age is(61.83±7.94)years old,body weight is(79.85±10.29)kg and BMI is(27.68±2.43)kg/m2,respectively.There was no significant difference in age,sex,body weight,BMI,waist circumference,hip circumference,fasting blood glucose,glycosylated hemoglobin,TC,TG,HDL-C,LDL-C,ALT,AST,uric acid,creatinine,eGFR,CIMT and VAI between the two groups before treatment.2.After 12 months of treatment,the body weight,BMI,waist circumference,hip circumference and VAI of the two groups were significantly lower than those before treatment.The levels of systolic blood pressure and diastolic blood pressure in the dapagliflozin group were lower than those before treatment(p<0.05),but the changes of systolic blood pressure and diastolic blood pressure in the control group were not significant(p>0.05).In dapagliflozin group,TG decreased and HDL-C increased after treatment,but TC and LDL-C did not change significantly.There were no significant changes in TC,TG,HDL-C and LDL-C in the control group.HbA1c and FPG decreased in both groups,but there were no significant changes in ALT,AST,eGFR,CIMT,uric acid and creatinine before and after treatment.3.The decrease of body weight,BMI and waist circumference before and after treatment in the dapagliflozin group was significantly higher than that in the control group(p<0.05),but there was no significant difference in hip circumference between the two groups.The decrease of VAI in dapagliflozin group was significantly higher than that in control group.There was no significant difference in the decrease of HbA1c and FPG between the two groups before and after treatment.The decrease of systolic blood pressure in dapagliflozin group was significantly higher than that in control group,but there was no significant difference in diastolic blood pressure between the two groups.There was significant difference in the decrease of TG and the increase of HDL-C between the two groups.There was no significant difference in the difference of TC,LDL-C,CIMT,eGFR and creatinine between the two groups before and after treatment.4.At the end of follow-up,there was no significant difference in hypoglycemic drugs,antihypertensive drugs and lipid-regulating drugs between the two groups(p>0.05).5.The changes of VAI before and after treatment were taken as dependent variables,and each hypoglycemic,hypotensive and lipid-lowering drugs as independent variables were analyzed by multiple stepwise regression analysis.the variables introduced into the regression equation were dapagliflozin and GLP-1RA.6.After 12 months of follow-up,there were 2 cases of hypoglycemia in the dapagliflozin group(1.9%)and 3 cases in the control group(2.8%).There was no significant difference in the incidence of hypoglycemia between the two groups(p>0.05).There were 3 patients with urinary system symptoms in the dapagliflozin group,accounting for 2.8%.There was no urinary system adverse reaction in the control group during the treatment period.There was no significant difference in the incidence of urinary system adverse reactions between the two groups(p>0.05).There were 2 cases of digestive system adverse reactions in each of the two groups,and there was no significant difference between the two groups(p>0.05).During the follow-up period,there was no diabetic ketoacidosis in the dapagliflozin group,but there was 1 case of diabetic ketoacidosis in the control group(0.9%).There was no significant difference between the two groups(p>0.05).Conclusion:Dapagliflozin can significantly reduce the levels of blood glucose,HbAlc,body weight,BMI,waist circumference,hip circumference,TG and VAI in patients with type 2 diabetes,increase the level of HDL-C,improve lipid metabolism,and have no effect on liver and kidney function.