关键词: 钠-葡萄糖协同转运蛋白-2抑制剂, 2型糖尿病, 血糖, 脂代谢, 体成分

Abstract: Objective To evaluate the effects of sodium-glucose cotransporter protein 2(SGLT-2)inhibitor, dapagliflozin, on various body fat parameters in overweight and obese patients with type 2 diabetes, and to explore its effects on lipid metabolism and visceral adipose tissues and the potential mechanism. Methods A total of 60 hospitalized patients with type 2 diabetes who had poor blood glucose control before admission were randomly selected, including 46 males and 14 females, aged 35-65 years, average 50 years. The patients were randomly divided into control group(n=30)and dapagliflozin(Adatang)treatment group(n=30). Diabetes education was conducted in both groups. In the control group, insulin, oral antidiabetic drugs or combination medication with non-SGLT2 inhibitors were adjusted. In the dapagliflozin treatment group, 10 mg/d dapagliflozin was combined with prior insulin or oral antidiabetic drugs for 山 东 大 学 学 报 (医 学 版)57卷6期 -姜立娟,等.达格列净改善超重及肥胖2型糖尿病患者脂代谢及内脏脂肪含量 \=-12 weeks. Parameters were recorded, including age, sex, blood glucose, glycosylated hemoglobin, blood lipid, baseline and post-treatment body composition in both groups; 24 h glycosuria quantitative and electrolytes, baseline and post-treatment blood biochemical indicators in the dapagliflozin treatment group. The incidence of adverse reactions such as urinary tract infection, genital tract infection, hypoglycemia and abnormal renal function in both groups were recorded. Results There were no statistical differences in age, sex, baseline values of glycosylated hemoglobin and body weight between the two groups(P>0.05). After 12 weeks of treatment, blood glucose was effectively controlled in both groups(P<0.01). In terms of lipid parameters, dapagliflozin significantly reduced triglyceride(P<0.05)and increased high-density lipoprotein(P<0.01), but had no significant effects on cholesterol or low-density lipoprotein(P>0.05). There was no significant change in blood lipid in the control group(P>0.05). Dapagliflozin significantly reduced the area and mass of visceral adipose tissues(P<0.01), but had no significant effects on body mass, percentage of body fat, skeletal muscle index of limbs, and bone mineral content(P>0.05). Moreover, there was a significant increase in 24 h glycosuria quantitative in the dapagliflozin treatment group(P<0.01), but no significant difference in 24 h urine electrolytes, blood electrolytes, blood routine and renal function(P>0.05). During the treatment, there was no significant difference in adverse reactions between the two groups(P>0.05). Conclusion Dapagliflozin can significantly reduce blood glucose, triglycerides, and area and mass of visceral adipose tissues in patients with type 2 diabetes, while increase high-density lipoprotein. It can reduce the risk of cardiovascular diseases, but at the same time it has no significant effects on renal function and electrolytes. It does not increase the incidence of renal impairment and hypoglycemia. Dapagliflozin is safe and effective for patients with type 2 diabetes.

Key words: sodium-glucose cotransporter protein 2 inhibitor, Type 2 diabetes, Blood glucose, Lipid metabolism, Body composition