恩格列净联合二甲双胍治疗老年2型糖尿病的效果及对骨代谢和临床终点事件发生率的影响

Effects of empagliflozin combined with metformin in the treatment of elderly patients with type 2 diabetes mellitus and its in-fluence on bone metabolism and incidence of clinical endpoint events

中文关键词: 老年  2型糖尿病  恩格列净  二甲双胍  血糖水平  心功能

英文关键词: elderly  type 2 diabetes mellitus  empagliflozin  metformin  blood glucose level  cardiac function

中文摘要:

      目的 探究恩格列净联合二甲双胍对老年2 型糖尿病(T2DM)患者的效果及对骨代谢、临床终点事件发生率的影响.方法 回顾性分析2020 年1 月—2021 年12 月于广安市人民医院就诊的老年T2MD患者360 例的临床资料,根据不同治疗方案分为观察组和对照组,每组180 例.对照组患者给予二甲双胍治疗,观察组给予二甲双胍联合恩格列净治疗.对比2 组治疗前后血糖、胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)、体质量(BMI)、腰臀比、血压、左心室射血分数(LVEF)、骨代谢及骨密度变化;随访至少 1.5 年,记录 2 组患者临床终点事件发生率.结果 治疗后,观察组空腹血糖(FPG)、餐后2h血糖(2 h PG)、糖化血红蛋白(HbAlc)、HOMA-IR指标值均低于对照组,而HOMA-β值高于对照组,差异均有统计学意义(P＜0.05);观察组BMI、腰臀比、收缩压(SBP)值均低于对照组,而LVEF值高于对照组,差异均有统计学意义(P＜0.05);2 组患者PⅠNP、β-CTX、腰L1-4 骨密度值差异均无统计学意义(P＞0.05);观察组患者尿酮体阳性发生率高于对照组(10.56%vs 1.11%),复合非致命性心血管疾病发生率低于对照组(13.33%vs 21.67%),差异均有统计学意义(P＜0.05).结论 二甲双胍基础上加用恩格列净治疗老年T2MD,可改善患者血糖水平、胰岛功能,减轻体质量,降低血压、心脏负荷,减少临床终点事件发生率,短时间内对骨密度无明显影响;治疗期间需密切关注患者发生不良反应情况,并及时处理.

英文摘要:

      Objective To investigate the effects of empagliflozin combined with metformin in the treatment of elderly patients with type 2 diabetes mellitus(T2DM)and its influence on bone metabolism and incidence of clinical endpoint events.Methods The clinical data of 360 elderly T2MD patients treated in People's Hospital of Guang'an City from January 2020 to December 2021 were retrospectively analyzed.According to different treatment methods,they were divided into observation group and control group,with 180 cases in each group.The observation group was treated with empagliflozin combined with metformin,and the control group was treated with metformin.The changes of blood glucose,homeostatic model assessment of insulin resistance index(HOMA-IR),islet beta cell function index(HOMA-β),body mass index(BMI),waist-to-hip ratio,blood pressure,left ventricular ejection fraction(LVEF),bone metabolism and bone mineral density were compared between the two groups before and after treatment.The patients were followed for at least 1.5 years,and the incidence of clinical end-point events in both groups was recorded.Results After treatment,the fasting plasma glucose(FPG),2 h postprandial blood glucose(2 hPG),glycosylated hemoglobin A1c(HbAlc)and HOMA-IR of the observation group were lower than those of the control group(P＜0.05),while HOMA-β was higher than that of the control group(P＜0.05);BMI,waist-to-hip ratio and systolic blood pressure(SBP)of the observation group were lower than those of the control group(P＜0.05),and LVEF was higher than that of the control group(P＜0.05).There was no statistical significance in PⅠNP,β-CTX and bone mineral density of lumbar L1-4 between the two groups(P＞0.05).The incidence of urinary ketone body positive in the observation group was higher than that in the control group(10.56% vs 1.11% ),while the incidence of complex nonfatal cardiovascular disease was lower than that in the control group(13.33% vs21.67% ),with statistical significance(P＜0.05).Conclusion On the basis of metformin,the addition of empagliflozin in the treatment of elderly T2MD patients can improve blood glucose lev-els and islet function,reduce body weight,lower blood pressure and cardiac load,and reduce the incidence of clinical endpoint events.It has no significant effect on bone mineral density in a short time.In addition,it is necessary to pay closely attention to the occurrence of adverse reactions and timely take symptomatic treatment during treatment.