内科

目的分析度拉糖肽联合二甲双胍、达格列净对初诊2型糖尿病（T2DM）患者糖脂代谢的影响。方法选择140例初诊 T2DM患者作为研究对象，并将其随机分为对照组和观察组，各70例。对照组行基础治疗+餐时胰岛素方案（甘精胰岛素+餐前门冬胰岛素联合二甲双胍片）治疗，观察组行221方案（度拉糖肽联合二甲双胍片、达格列净片）治疗，两组均接受为期8周的治疗，并于治疗8周后开始随访。分别于治疗前、治疗8周后，以及随访第4周、第8周、第12周时比较两组患者空腹血糖（FBG）、餐后2h血糖（2hPBG）、糖化血红蛋白（HbA1c）、空腹C肽（FCP）、餐后2小时C肽（2hPCP）、总胆固醇（TC）、三酰甘油（TAG）水平，观察两组患者治疗期间轻度恶心、尿路感染、轻度腹胀等副作用的发生情况。结果治疗前，两组患者FBG、2hPBG、FCP、2hPCP、HbA1c、TC、TAG水平差异均无统计学意义（均P＞0.05）。治疗8周后，观察组患者FBG、2hPBG、HbA1c、TC、TAG水平均低于对照组，FCP、2hPCP水平均高于对照组（均P＜0.05）。随访第4周、第8周、第12周时，观察组患者FBG、2hPBG、HbA1c、TC、TAG水平均低于对照组患者，FCP、2hPCP水平均高于对照组患者（均P＜0.05）。观察组患者治疗期间副作用发生率（8.57%）低于对照组患者（21.43%）（P＜0.05）。结论相较于常规治疗，度拉糖肽联合二甲双胍、达格列净治疗初诊T2DM患者可更有效地改善其糖脂代谢异常，安全性更高。

ObjectiveTo analyze the effects of dulaglutide combined with metformin and dapagliflozin on glycolipid metabolism in patients with newly diagnosed type 2 diabetes mellitus (T2DM). MethodsA total of 140 patients with newly diagnosed T2DM were selected as research objects and randomly divided into a control group or an observation group, with 70 cases in each group. The control group received basic therapy + mealtime insulin regimen (glargine insulin + preprandial insulin aspart combined with metformin tablets), while the observation group received 221 regimen (dulaglutide combined with metformin tablets and dapagliflozin tablets), both groups were treated for 8 weeks, and the follow-up began after the 8-week treatment. The levels of fasting blood glucose (FBG), 2h postprandial blood glucose (2hPBG), hemoglobin A1c (HbA1c), fasting C-peptide (FCP), 2h postprandial C-peptide (2hPCP), total cholesterol (TC), and triacylglycerol (TAG) were compared between the two groups before and after the 8-week treatment，and at the 4th week, 8th week and 12th week of follow-up. The incidence of mild nausea, urinary tract infection, mild abdominal distention, and other side effects were observed in the two groups during the treatment. ResultsBefore the treatment, there was no statistically significant difference in the FBG, 2hPBG, FCP, 2hPCP, HbA1c, TC or TAG level between the two groups (all P＞0.05). After the 8-week treatment, the FBG, 2hPBG, HbA1c, TC, and TAG levels in the observation group were lower than those in the control group, while the FCP and 2hPCP levels were higher than those in the control group (all P＜0.05). At the 4th, 8th and 12th week of follow-up, the FBG, 2hPBG, HbA1c, TC and TAG levels in the observation group were lower than those in the control group, while the FCP and 2hPCP levels in the observation group were higher than those in the control group (all P＜0.05). During the treatment, the observation group had a lower incidence of side effects than the control group (8.57% vs. 21.43%) (P＜0.05). ConclusionCompared with the conventional treatment, dulaglutide combined with metformin and dapagliflozin can improve the abnormal glycolipid metabolism of newly diagnosed T2DM patients more effectively and with higher safety.