Comparison The Efficacy Of Liraglutide、Saxagliptin And Insulin Detemir In Treatment Of Type 2 Diabetes Mellitus Inadequately Controlled

Objective: To explore therapy for 12 weeks’ efficacy of liraglutide、saxagliptin versus insulin detemir in patients with Type 2 Diabetes Mellitus(T2DM) inadequately controlled on Oral hypoglycemic drugs alone.Methods: Elect 72 alone or metformin in combination with other oral antidiabetic drugs, glycosylated hemoglobin 7.5% ~ 10%, with a body mass index ≤40kg / m2Type2 Diabetes Mellitus inadequately controlled that got treatment in inpatients or outpatients at Endocrinology Department of the Second Affiliated Hospital of Dalian Medical University from December 2012 to June 2014,46 patients agreed to accept the treatment of subcutaneous injection, 46 patients were randomized 1:1 divided into liraglutide group and insulin detemir group, 26 patients for the saxagliptin group.Subjects disable other oral hypoglycemic drugs in addition to metformin outside,respectively received the treatment of 12 Zhou liraglutide, saxagliptin or insulin detemir combined with metformin. Detection of glucose metabolism indexes before and after treatment 、 body weight 、 BMI 、 lipids 、 fasting C peptide level(FC-P) 、 insulin resistance index(HOMA-IR) 、 islet beta cell function(HOMA- beta) 、 uric acid 、Microalbuminuria 、 liver function, and record adverse reactions occurred during the treatment period.Results : 1 、 64 patients completed the experiment, liraglutide group 21 cases completed the fall off in 2 cases, saxagliptin 23 cases completed the fall off in 3 cases,insulin detemir group 20 cases completed the fall off in 3 cases. Baseline general dataand indicators of the three groups of patients has good comparability.2、After 12 weeks of treatment, blood glucose compared with before treatment,liraglutide treatment group, saxagliptin treatment group and insulin detemir treatment group FBG, 2h PG, Hb A1 c decreased significantly(P< 0.01); comparison between groups, liraglutide group FPG decrease with insulin detemir group similar,no significant difference(p>0.05), two groups of FPG decline margins were higher than the saxagliptin group, the difference was significant(p<0.05), the 2h PG between three groups had similar drop, no significant difference(p>0.05), liraglutide group Hb A1 c decrease are similar with insulin detemir group, no significant difference(p>0.05), two groups of Hb A1 c decline were higher than the saxagliptin group, the difference was significant(p<0.05), after treatment the three group of Hb A1 c less than or equal to 7%of the compliance rate is rather,differences between the three groups was not significant(p>0.05).3、After 12 weeks of treatment,liraglutide group weight、BMI significantly lower than before treatment, the difference was significant(p<0.05), saxagliptin group body weight 、 BMI decreased after treatment, differences have not yet reached statistical significance(p> 0.05), insulin detemir group after treatment, body weight did not change significantly; comparison between groups, liraglutide group body weight and BMI decreased amplitude was higher than that of saxagliptin group and insulin detemir group, the difference was statistically significant(p<0.05).4、After 12 weeks of treatment, blood lipids compared with those before treatment,liraglutide group TC, TG was significantly lower than before treatment(P<0.05),saxagliptin group and the insulin detemir group TC,TG,LDL-C,HDL-C was no significant changes after treatment(P>0.05); comparison between groups,the liraglutide group TC、TG decline degree were higher than the other two groups(P<0.05).5 、 After 12 weeks of treatment,islet function compared with those before treatment, three groups of FC-P all was improved(P<0.01), liraglutide group and saxagliptin group HOMA- β 、 HOMA-IR were improved(respectively P<0.05,P<0.01);comparison between groups, liraglutide group FC-P improvement was greaterthan the saxagliptin group and insulin detemir group(P<0.05), HOMA-IR improvement,liraglutide group and saxagliptin group the level of improve were similar(P>0.05), the two group were higher than the insulin detemir group(P<0.05), HOMA- β improvement,liraglutide group improved level were higher than the saxagliptin group and insulin detemir group(P<0.05).6、After 12 weeks of treatment, the blood pressure compared with those before treatment, three groups of SBP, DBP were all improved, compared with the baseline systolic blood pressure,liraglutide group was decreased(P<0.01),compared with baseline systolic blood pressure saxagliptin group and the insulin detemir group had no significant difference(P>0.05); comparison between groups, liraglutide group in control of SBP is obviously better than the rest the two group, the difference was significant(P<0.05), but no significant difference between the three groups of the effect on DBP(p>0.05).7 、 Security, overall liraglutide group the gastrointestinal incidence of adverse reactions is higher, but the shorter, more occurred within the 1-2 week time, then had the similar incidence with the the two groups. The three group T2 DM patients were no serious adverse reactions, no severe hypoglycemia and nocturnal hypoglycemia, insulin detemir group was high incidence of mild hypoglycemia, the adverse reaction can be self or relieved by symptomatic treatment.Conclusion:1 、 Metformin respectively combined with liraglutide 、 saxagliptin and insulin detemir can improve blood glucose those with type 2 diabetes Mellitus(T2DM) inadequately controlled on Oral hypoglycemic drugs alone,the efficacy of liraglutide and insulin detemir reduce FPG and Hb A1 c is similar, better than saxagliptin.2 、 Compared with insulin detemir, liraglutide and saxagliptin have more significantly decreased body weight, improve blood lipid, restoring the function of islet beta cells, relieve insulin resistance, reduce the effect of systolic blood pressure and hypoglycemic, in addition liraglutide is better than sand sitagliptin.3、The occurrence of liraglutide gastrointestinal adverse reaction rate is higher,but relatively short-lived, more occurred within the first 1-2 weeks time.