司美格鲁肽联合二甲双胍治疗肥胖2型糖尿病患者的效果及对内脏肥胖指数的影响

The effect of semaglutide combined with metformin on obesity in type 2 diabetes and its impact on visceral fat index

摘要:

目的 探讨司美格鲁肽联合二甲双胍治疗肥胖2型糖尿病（T2DM）的效果及对内脏肥胖指数（VAI）的影响。方法 选取2022年1月—2023年6月在深圳市龙岗中心医院就诊的肥胖T2DM患者116例，随机分为对照组和试验组，各58例。两组患者均口服二甲双胍1.0 g/次，2次/d。对照组早餐前皮下注射利拉鲁肽，起始剂量0.6 mg/d，第2周加量至1.2 mg/d维持治疗12周。试验组给予司美格鲁肽皮下注射，每周注射1次，起始剂量0.25 mg，4周后增至0.5 mg并维持。血糖控制不佳者，于0.5 mg给药剂量连续治疗4周后调整至1.0 mg维持。维持治疗12周。比较两组的血糖血脂、体质量指数（BMI）、内脏肥胖指数（VAI）、胰岛素抵抗指数（HOMA-IR）。记录不良反应。结果 试验组治疗前后空腹血糖（FBG）、餐后2 h血糖（2 hPBG），糖化血红蛋白（HbA1c），低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、甘油三酯（TG）、总胆固醇（TC）、体质量指数（BMI）、VAI、HOMA-IR的差值均大于对照组（P <0.05）。两组总不良反应发生率比较，差异无统计学意义（P >0.05）。结论 司美格鲁肽联合二甲双胍治疗肥胖T2DM患者，可降低血糖水平，调节脂质代谢，降低VAI，且安全性良好。

Abstract:

Objective To explore the effects of semaglutide combined with metformin in the treatment of obesity in type 2 diabetes (T2DM) and its impact on the visceral adiposity index (VAI).Methods Obese T2DM patients were randomly divided into a control group and a treatment group. Both groups were treated with oral metformin, 1.0 g per dose, twice daily. The control group received subcutaneous liraglutide injection before breakfast, starting with a dose of 0.6 mg·day-1, which was increased to 1.2 mg·day-1 in the second week and maintained for 12 weeks. The treatment group was given subcutaneous injection of semaglutide once a week, with an initial dose of 0.25 mg, which was increased to 0.5 mg after 4 weeks and maintained. For those with poor blood glucose control, the dosage of 0.5 mg was adjusted to 1.0 mg for maintenance after 4 weeks of continuous treatment.he blood glucose and lipid levels, body mass index (BMI), visceral adiposity index (VAI), and insulin resistance index (HOMA-IR) were compared between the two groups. Adverse reactions were recorded.Results The differences in FBG, 2hPBG, HbA1c, LDL-C, TG, TC, BMI, VAI, and HOMA-IR before and after treatment were significantly greater in the experimental group than in the control group (P < 0.05). The differences in FBG, 2 hPBG, HbA1c, LDL-C, TG, TC, BMI, VAI, and HOMA-IR before and after treatment were found to be significantly greater in the experimental group than in the control group (P < 0.05). The total incidence of adverse reactions was compared between the two groups, with no statistically significant difference being observed by χ2 test (P > 0.05).Conclusion Semaglutide combined with metformin in the treatment of obesity-related T2DM helps to lower blood glucose levels, regulate lipid metabolism, reduce VAI, and demonstrates good safety.