The Clinical Effect Of Liraglutide Sequentially Combined With Insulin Pump And Basal Insulin On Preliminarily Diagnosed Overweight And Obese Patients With Type 2 Diabetes Mellitus

BackgroundDiabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia,which is caused by a variety of factors including heredity and environment.The main performance of T2 DM is inadequate secretion of insulin with insulin resistance,accounting for about 90% of the patients with DM.Overweight and obesity are independent risk factors for T2 DM,and patients with T2 DM are often associated with overweight and obesity.GLP-1 receptor agonist(GLP-1RA)has came into the market in 2005 and has been widely used in clinic for its recognized effect of weight loss.In recent years,the combination of GLP-1RA and insulin have been paid more and more attention in foreign countries for the favorable effect of reduction of plasma glucose and weight loss.However,there are relatively few related researches in China.Therefore,we conducted a study on the clinical effect of GLP-1RA combined insulin on overweight and obese patients with T2 DM in order to explore new treatments for overweight and obese patients with T2 DM.ObjectiveTo observe the clinical effect of liraglutide sequentially combined with insulin pump and basal insulin on glucose metabolism,insulin secretive function,weight,blood lipid level in preliminarily diagnosed overweight and obese patients with T2 DM.MethodsPreliminarily diagnosed overweight and obese patients with T2 DM which were treated in the department of endocrinology,the First Affiliated Hospital of Zhengzhou University from january 2017 to february 2018 were collected,The study was divided into two phases: the first stage(2 weeks of intensive treatment):Patients were randomly divided into two groups by Simple randomization: the research group and the control group.Patients in the research group were treated with the insulin pump combined with liraglutide and metformin while patients in the control group were simply treated with insulin pump and metformin.The dose of liraglutide began at 0.6mg/ day.In the first stage 2 groups were compared with insulin dosage,the number of days required to meet blood glucose standard,the rate of reaching fasting and postprandial blood glucose standard.The second stage(3 weeks-3 months):Insulin pump were removed in both groups after 2 weeks,and instead of basal insulin(The total amount of insulin is greater than or equal to 20U).In the second stage the following indicators between groups before and after treatment and the difference between two groups after treatment were compared: weight(W),body mass index(BMI),waist circumference(WC),hip circumference(HC),waist-hip ratio(WHR),glycosylated hemoglobin(HbA1c),fasting blood glucose(FPG),blood glucose 2 hours after steamed bun test(2hPG),fasting C peptide(FC-P),C peptide 2 hours after steamed bun test(2hC-P),cholesterol(TC),triglyceride(TG),high density lipoprotein(HDL),low density lipoprotein(LDL),monitoring adverse events such as hypoglycemia,gastrointestinal adverse reactions and so on.Results72 cases of preliminarily diagnosed overweight and obese T2 DM were collected,including 41 males and 31 females.There were 36 cases in both groups.In the research group,there were 21 male patients,15 female patients,age from 24-48 years,the average age were(34.00±5.61)years.In the control group,there were 20 male patients,16 female patients,age from 22-51 years,the average age were(35.25±6.66)years.The first stage(2 weeks of intensive treatment): liraglutide combined with insulin pump,compared with the control group,the dosage of insulin before removing the insulin pump was significantly lower(P < 0.01),the number of days required to meet blood glucose standards were lower(P < 0.05),the rate of reaching fasting and postprandial blood glucose standard was significantly higher in the research group(P < 0.01).The second stage(3 weeks-3 months): liraglutide combined with basal insulin 1.the lever of HbA1 c,FPG,2hPG decreased,FC-P,2hC-P increased in both two groups(P < 0.05),and HbA1 c,FBG,2 hPG were lower,FC-P,2hC-P were higher in the research group(P < 0.05).2.W,BMI,WC,HC reduced in the research group(P < 0.05),W,BMI,WC,HC elevated in the control group(P < 0.05),W,BMI,WC,WHR were significantly lower in the research group(P < 0.05),while HC difference had no statistical significance(P > 0.05).3.TC,TG and LDL-C decreased,HDL-C increased in both groups(P < 0.05),TC,TG and LDL-C were lower,HDL-C was higher in the research group(P < 0.05).4.Adverse reactions were nausea(9 cases,25%),vomit(4 cases,11.1%),diarrhea(3 cases,8.3%),hypoglycemia events(3 patients 5.5%)in the research group,hypoglycemia events(3 cases,5.5%)in the control group.Conclusion1.Liraglutide sequentially combined with insulin pump and basal insulin can reach the glucose standard more quickly,enhance the insulin secretive function,significantly reduce weight and blood lipid level in preliminary diagnosed overweight and obese patients with T2 DM.2.Liraglutide combined with insulin is safe and does not increase the incidence of hypoglycemia events.Except for mild gastrointestinal adverse disorders,there are no significant increase in adverse reactions.