| Objective:To observe the clinical effect of Sodium-glucose cotransporter-glucose cotransporter 2 inhibitor(SGLT-2i)in the treatment of adult patients with type 2 diabetes mellitus(T2DM)complicated with chronic kidney disease,and provide some references for the clinical drug use.Methods:1.Outpatients with T2DM and CKD who had been inadequately controlled by lifestyle intervention and metformin with or without other hypoglycemic drugs between December 2019 and December 2020 in the Affiliated Hospital of North Sichuan Medical College were selected,those who agreed to use SGLT-2i were included in the treatment group,those who disagreed to use SGLT-2i were included in the control group,200 in each group,and all patients signed an informed consent.There were 136 males and 64 females in the treatment group,with an average age of(55.49±7.60)years and an average duration of diabetes(6.91±4.28)years.There were 132 males and 68 females in the control group,with an average age of(54.16±8.43)years and an average duration of diabetes(6.29±4.14)years.Among them,68 patients in the treatment group were complicated with hypertension,109 patients with dyslipidemia,42 patients with hyperuricemia,50 patients with baseline insulin hypoglycemia,and 37 patients with baseline use of RASS blockers.In the control group,there were 59 cases of hypertension,111 cases of dyslipidemia,43 cases of hyperuricemia,43 cases of baseline insulin hypoglycemia,and 40 patients with baseline use of RASS blockers.In the treatment group,on the basis of the original hypoglycemic drugs,SGLT-2i was added to the treatment group for 10 mg,once a day,before breakfast.The patients in the control group were treated with adjusting the dose of the original hypoglycemic regimen or adding other oral hypoglycemic drugs(except SGLT-2i and GLP-1 receptor agonists).The patients were treated continuously for 24 weeks and followed up.During the treatment,two groups of patients were given diabetes health education to guide healthy diet and exercise.Hypoglycemia was judged by blood glucose≤3.9mmol/l and/or need help.2.The body weight,systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FPG),glycosylated hemoglobin(HbA1c),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),blood urea nitrogen(BUN),serum creatinine(Cr),glomerular filtration rate(eGFR),serum uric acid(UA),urinary albumin creatinine ratio(UACR)were recorded before and after treatment.Meanwhile,recorded the insulin dose before and after treatment in patients with baseline insulin hypoglycemia,and observe the incidence of genitourinary tract infection,diabetic ketoacidosis(DKA),hypoglycemia,fracture and acute renal injury(AKI),etc during treatment.3.All the data were analyzed and processed by SPSS26 medical statistical software package.The measurement data were statistically analyzed according to the original value.The measurement results were expressed as mean±standard deviation(X±s).T-test was used to compare the measurement data between groups.Chi-square test was used for numeration data,and all tests were judged by(P<0.05).Results:1.The levels of FPG and HbAlc in the treatment group and the control group after treatment were lower than those before treatment,and the difference was statistically significant(t=6.37,t=6.96,P<0.05).When there was no hypoglycemia,the decrease in the treatment group was more obvious than the control group,and the difference was statistically significant(t=2.420,t=2.225,P<0.05).2.The levels of body weight,TG,UACR and UA in the treatment group after treatment were significantly lower than those before treatment(t=2.020,t=1.982,t=2.037,t=2.139,P<0.05).There was no significant difference in the levels of SBP,DBP,TC,HDL-C,LDL-C,BUN,Cr and eGFR between before and after treatment(t=0.256,t=0.3 76,t=0.920,t=0.576,t=0.337,t=0.378,t=0.601,t=0.510,P>0.05).3.The levels of body weight,SBP,DBP,TG,TC,HDL-C,LDL-C,BUN,Cr,UA,eGFR and UACR in the control group after treatment were not significantly different from those before treatment(t=0.419,t=0.820,t=-0.179,t=1.163,t=1.421,t=-1.054,t=1.642,t=1.500,t=-0.608,t=1.580,t=0.235,t=0.094,P>0.05).4.After treatment,the insulin dose of the patients receiving insulin hypoglycemic treatment at beginning in the treatment group was significantly lower than that before treatment(t=1.996,P<0.05).There was no significant difference in insulin dose between the patients with insulin hypoglycemic treatment before and after treatment in the control group(t=2.225,P>0.05).5.After treatment,the level of UACR in the patients who received RASS blockers at baseline in the treatment group was not lower than that before treatment,and the difference was not statistically significant(t=0.851,P>0.05).6.During the follow-up period,there were 2 cases of mild urinary tract infection in the treatment group,and 1 case in the control group,which were improved after routine treatment.No adverse reactions such as hypoglycemia,DKA,peripheral vascular disease,amputation,fracture,bladder cancer and AKI were observed in the two groups during the trial.Conclusions:1.SGLT2i can effectively reduce UACR and improve the efficacy of T2DM patients with CKD.2.SGLT2i can effectively improve the blood glucose index and reduce the dosage of insulin in T2DM patients with CKD without increasing hypoglycemia.3.SGLT2i can reduce body weight,improve blood lipids and reduce uric acid.4.In this study,it was not observed that SGLT2i increased genitourinary tract infection,hypoglycemia,DKA,peripheral vascular disease,amputation,fracture,bladder cancer,AKI and other adverse reactions in T2DM patients with CKD. |
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