内科

目的探讨在口服二甲双胍基础上，德谷胰岛素利拉鲁肽对比基础胰岛素治疗老年2型糖尿病（T2DM）合并冠心病心功能不全患者的疗效与安全性。方法选取2023年11月至2024年11月疏勒县人民医院内分泌科收治的80例老年T2DM合并冠心病心功能不全患者作为研究对象，并采用随机数字表法将其分为对照组与观察组，每组40例。两组均接受饮食、运动干预及抗血小板、降压、调脂等常规治疗；在此基础上，对照组采用口服二甲双胍联合皮下注射德谷胰岛素治疗，观察组采用口服二甲双胍联合皮下注射德谷胰岛素利拉鲁肽治疗，两组疗程均为3个月。比较两组治疗前后的糖代谢指标［空腹血糖（FBG）、餐后2 h血糖（2hPBG）、糖化血红蛋白（HbA1c）］、胰岛素抵抗与身体成分指标［稳态模型评估胰岛素抵抗指数（HOMA-IR）、身体质量指数（BMI）］、炎症因子［白细胞介素（IL）-6］、心功能与运动耐量［左室射血分数（LVEF）、左室舒张末期内径（LVEDD）、脑利尿钠肽（BNP）、6 min步行距离］，以及治疗期间心脏事件、不良反应发生情况。结果治疗前，两组HOMA-IR、BMI、LVEF、LVEDD、6 min步行距离及FBG、2hPBG、HbA1c、血清IL-6、血浆BNP水平差异均无统计学意义（均P>0.05）。治疗3个月后，观察组HOMA-IR、BMI、LVEDD及FBG、2hPBG、HbA1c、血清IL-6、血浆BNP水平均低/小于对照组，LVEF高于对照组，6 min步行距离长于对照组（均P<0.05）。治疗期间，观察组患者心脏事件总发生率低于对照组（P<0.05），两组患者不良反应总发生率差异无统计学意义（P>0.05）。结论对于老年T2DM合并冠心病心功能不全患者，在二甲双胍基础上联合德谷胰岛素利拉鲁肽，较联合基础胰岛素能更有效地改善糖代谢、胰岛素抵抗及身体成分指标，减轻炎症状态，优化心功能并提升运动耐量，同时有助于降低心脏事件发生率，且不增加低血糖等不良反应风险。

Objective To investigate the efficacy and safety of insulin degludec and liraglutide versus basal insulin, both in combination with oral metformin, in treating elderly type 2 diabetes mellitus (T2DM) patients with coronary heart disease and cardiac insufficiency. Methods Eighty elderly T2DM patients with coronary heart disease and cardiac insufficiency admitted to the Department of Endocrinology, Shule County People's Hospital from November 2023 to November 2024 were selected as the study subjects, and they were randomly divided into a control group or an observation group using a random number table, with 40 patients in each group. Both groups received diet and exercise interventions, along with conventional treatments including antiplatelet therapy, antihypertensives, and lipid-lowering agents; on this basis, the control group received oral metformin combined with subcutaneous injection of insulin degludec, the observation group received oral metformin combined with subcutaneous injection of insulin degludec and liraglutide, and the treatment course for both groups was 3 months. Glycemic metabolism indicators (fasting blood glucose [FBG], 2-hour postprandial blood glucose [2hPBG], and glycated hemoglobin [HbA1c]), insulin resistance and body composition indicators (homeostasis model assessment of insulin resistance [HOMA-IR] and body mass index [BMI]), inflammatory factor (interleukin [IL]-6), cardiac function and exercise tolerance (left ventricular ejection fraction [LVEF], left ventricular end-diastolic diameter [LVEDD], brain natriuretic peptide [BNP], and 6-minute walking distance) before and after treatment, as well as the occurrence of cardiac events and adverse reactions during treatment, were compared between the two groups. Results Before treatment, there was no statistically significant difference between the two groups in HOMA-IR, BMI, LVEF, LVEDD, 6-minute walking distance, or level of FBG, 2hPBG, HbA1c, serum IL-6, or plasma BNP (all P>0.05). After 3 months of treatment, compared with the control group, the observation group had lower HOMA-IR, BMI, and LVEDD; reduced levels of FBG, 2hPBG, HbA1c, serum IL-6, and plasma BNP; higher LVEF; and a longer 6-minute walking distance (all P<0.05). During the treatment period, the total incidence of cardiac events in the observation group was lower than that in the control group (P<0.05), while there was no statistically significant difference in the total incidence of adverse reactions between the two groups (P>0.05). Conclusion For elderly T2DM patients with coronary heart disease and cardiac insufficiency, insulin degludec and liraglutide is more effective than basal insulin, when combined with metformin, in improving glycemic metabolism, insulin resistance, and body composition indicators; alleviating inflammatory status; optimizing cardiac function; and enhancing exercise tolerance. It also helps reduce the incidence of cardiac events without increasing the risk of adverse reactions such as hypoglycemia.

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