摘要
目的 探讨司美格鲁肽联合瑞格列奈对肥胖2型糖尿病(type 2 diabetes mellitus,T2DM)患者的治疗效果。方法 选取洛阳市东方人民医院2022年1月至2024年9月收治的肥胖T2DM患者102例,随机分为观察组和对照组,各51例。两组均给予基础治疗,对照组给予瑞格列奈,观察组给予司美格鲁肽联合瑞格列奈,疗程3个月。治疗3个月后比较两组患者的治疗效果,以及治疗前后糖化血红蛋白(HbA1c)、胰岛β细胞功能指数(HOMA-β)、空腹血糖(FPG)、餐后2 h血糖(2 hPG)、空腹胰岛素(FINS)、总胆固醇(TC)、胰岛素抵抗指数(HOMA-IR)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、体质量指数(BMI)、肌肉量、脂肪量、体脂比、内脏脂肪面积及不良反应发生率。结果 治疗后观察组患者的FPG、2 hPG、HbA1c水平分别为(7.06±0.64) mmol/L、(7.15±1.12) mmol/L、(6.63±0.54)%,明显低于对照组的(7.64±0.70) mmol/L、(8.17±1.25) mmol/L、(7.20±0.62)%,差异均有统计学意义(P<0.05);治疗后观察组患者的总有效率为96.08%,高于对照组的82.35%,差异有统计学意义(P<0.05);治疗后观察组患者的TC、TG、LDL-C水平分别为(3.26±0.43) mmol/L、(1.27±0.30) mmol/L、(1.96±0.35) mmol/L,明显低于对照组的(4.01±0.57) mmol/L、(1.69±0.34) mmol/L、(2.31±0.42) mmol/L,而HDL-C水平为(1.35±0.18) mmol/L,明显高于对照组的(1.17±0.15) mmol/L,差异均有统计学意义(P<0.05);治疗后观察组FINS、HOMA-IR分别为(9.96±1.33) mIU/mL、3.13±0.72,明显低于对照组的(11.28±1.47) mIU/mL、3.94±0.80,而HOMA-β较治疗前显著升高,且观察组患者的HOMA-β为(55.96±6.19)%,明显高于对照组的(51.86±5.52)%,差异均有统计学意义(P<0.05);治疗后观察组患者的内脏脂肪面积、脂肪量、体脂比、BMI、腰臀比分别为(168.91±5.28) cm^(2)、(34.24±2.06) kg、(37.11±2.14)%、(28.11±0.62) kg/m^(2)、0.91±0.05,明显低于对照组的(175.38±5.40) cm^(2)、(35.31±2.27) kg、(38.35±2.20)%、(30.24±0.75) kg/m^(2)、0.97±0.06,观察组肌肉量为(44.92±2.81) kg,明显高于对照组的(43.74±2.44) kg,差异均有统计学意义(P<0.05);两组患者的不良反应发生率比较差异无统计学意义(P>0.05)。结论 司美格鲁肽联合瑞格列奈治疗肥胖T2DM患者可改善胰岛功能,调控血糖血脂水平,减少体脂,安全有效。
Objective To investigate the therapeutic effect of semaglutide combined with repaglinide in obese patients with type 2 diabetes mellitus(T2DM).Methods A total of 102 obese T2DM patients admitted to Luoyang Dongfang People's Hospital from January 2022 to September 2024 were selected and randomly divided into an observation group and a control group,with 51 cases in each group.Based on basic treatment,patients in the control group were treated with repaglinide,and those in the observation group received semaglutide combined with repaglinide.The course of treatment lasted 3 months.After 3 months of treatment,the therapeutic effects of the two groups were compared.Glycated hemoglobin A1c(HbA1c),homeostasis model assessment of β-cell function(HOMA-β),fasting plasma glucose(FPG),2hour postprandial plasma glucose(2 hPG),fasting insulin(FINS),total cholesterol(TC),homeostasis model assessment of insulin resistance(HOMA-IR),high-density lipoprotein cholesterol(HDL-C),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),body mass index(BMI),muscle mass,body fat mass,body fat percentage,visceral fat area before and after treatment,and the incidence of adverse reactions were measured.Results After treatment,the observation group showed significantly lower levels of FPG,2 hPG,and HbA1c compared to the control group(all P<0.05):(7.06±0.64)mmol/L,(7.15±1.12)mmol/L,(6.63±0.54)%versus(7.64±0.70)mmol/L,(8.17±1.25)mmol/L,and(7.20±0.62)%,respectively.The total effective rate of the observation group was 96.08%,significantly higher than 82.35%in the control group(P<0.05).Following treatment,the levels of TC,TG,and LDL-C in the observation group were significantly lower than those in the control group(all P<0.05):(3.26±0.43)mmol/L,(1.27±0.30)mmol/L,and(1.96±0.35)mmol/L versus(4.01±0.57)mmol/L,(1.69±0.34)mmol/L,and(2.31±0.42)mmol/L,respectively;the HDL-C level was significantly higher than that in the control group:(1.35±0.18)mmol/L versus(1.17±0.15)mmol/L(P<0.05).The observation group also demonstrated significantly lower post-treatment FINS and HOMA-IR compared to the control group(P<0.05):(9.96±1.33)mIU/mL,3.13±0.72 versus(11.28±1.47)mIU/mL and 3.94±0.80,respectively.Moreover,HOMA-βlevels increased significantly in both groups from baseline,with the observation group's level being markedly higher than the control group's at(55.96±6.19)%vs(51.86±5.52)%(P<0.05).After treatment,the observation group had significantly lower visceral fat area,fat mass,body fat percentage,BMI,and waist-to-hip ratio than the control group(all P<0.05):(168.91±5.28)cm^(2),(34.24±2.06)kg,(37.11±2.14)%,(28.11±0.62)kg/m^(2),0.91±0.05 versus(175.38±5.40)cm^(2),(35.31±2.27)kg,(38.35±2.20)%,(30.24±0.75)kg/m^(2),and 0.97±0.06,respectively.Conversely,the muscle mass in the observation group was significantly higher than that in the control group:(44.92±2.81)kg vs(43.74±2.44)kg,P<0.05.There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion For patients with obese T2DM,the combination of semaglutide and repaglinide effectively improves islet function,regulates blood glucose and lipid levels,demonstrating a favorable safety and efficacy profile.
作者
冯娟娟
马沙
李柏龄
杨海波
FENG Juan-juan;MA Sha;LI Bai-ling;YANG Hai-bo(Department of General Practice,Luoyang Dongfang People's Hospital,Luoyang 471000,Henan,CHINA)
出处
《海南医学》
2026年第1期14-19,共6页
Hainan Medical Journal
基金
河南省洛阳市科技攻关项目(编号:2401080B)。
关键词
2型糖尿病
肥胖
司美格鲁肽
瑞格列奈
胰岛功能
Type 2 diabetes mellitus
Obesity
Semaglutide
Repaglinide
Islet function
